Treatment of acrodermatitis continua of Hallopeau with TNF-blocking agents: case report and review

Dermatology : International Journal for Clinical and Investigative Dermatology
Lluís PuigAgustín Alomar

Abstract

Acrodermatitis continua of Hallopeau (ACH) is a rare acropustular eruption, characterized by sterile pustules, paronychia and atrophic skin changes, onychodystrophy and osteolysis of the distal phalanges of the fingers and toes. It is considered to be a variant of pustular psoriasis with a chronic relapsing course and frequent refractoriness to many therapeutic modalities, which can be amenable to successful treatment by tumor necrosis factor alpha antagonists. We report 1 patient with pustular psoriasis and ACH whom we have treated successfully with etanercept (for 30 months) and then adalimumab (for 13 months and ongoing). Blanching was initially achieved with etanercept 50 mg twice a week, but suppression of periungual inflammation then required combination therapy with etanercept 50 mg twice a week and methotrexate 10 mg weekly; lower doses of both drugs did not allow complete control of the disease. Eventually, adalimumab 40 mg every 2 weeks has provided the most cost-effective response in this patient, allowing maintenance of response with partial nail regrowth under monotherapy.

Citations

Mar 10, 2016·Indian Journal of Dermatology·Akanksha Shah, Meena Makhecha
Jul 6, 2013·Dermatologic Clinics·Haley B Naik, Edward W Cowen
Sep 29, 2011·International Journal of Dermatology·Virendra N SehgalKingsuk Chatterjee
Nov 13, 2013·The Journal of Dermatological Treatment·Luisa Di CostanzoNicola Balato
Jan 16, 2018·The British Journal of Dermatology·H Bachelez
Apr 3, 2019·Journal of Cutaneous Medicine and Surgery·Khalad MaliyarMelinda J Gooderham
Jul 8, 2020·The Journal of Dermatology·Christian KromerRotraut Mössner
Feb 8, 2020·Journal of the European Academy of Dermatology and Venereology : JEADV·B HussonUNKNOWN « Groupe de Recherche sur le Psoriasis » de la Société Française de Dermatologie
Feb 26, 2019·SAGE Open Medical Case Reports·Erika L CrowleyMelinda J Gooderham
Oct 5, 2018·JAMA Dermatology·Abraham M KormanJennifer A Sopkovich
Jul 4, 2020·Expert Opinion on Drug Safety·Wen-Ming Wang, Hong-Zhong Jin

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