Acrodermatitis continua of Hallopeau: evolution of treatment options

Abstract

Ever since its inception, acrodermatitis continua of Hallopeau, has been recognized as an uncommon clinical entity which has been sparingly reported from across the globe. The attempt to have cumulative information on prevalent nomenclature, definition, reminiscences, and clinical overtures has brought differential diagnosis and diagnosis in sharp focus, the highlights of which are outlined. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics.

Acrodermatitis Continua of Hallopeau Treated Successfully with Ustekinumab and Acitretin after Failure of Tumour Necrosis Factor Blockade and Anakinra

“…On account of its low prevalence, there are no guidelines to manage this pathology. Topical treatments (topical steroids, calcipotriol, topical tacrolimus) are classically prescribed as first-line therapy; systemic treatments such as acitretin, methotrexate or ciclosporin can be efficient in some cases [1]. …”

A Painful Periungual Red Spot in a Patient with Onychodystrophy

“…Pustulation of the nail bed and matrix leads to nail dystrophy, which is primarily seen as nail plate destruction, shedding, onycholysis, and anonychia. Desiccation of pustules usually leaves red, glazed areas with scales [1,2,3]. The patient presented here had typical clinical features of ACH.…”

“…ACH is often refractory to treatment, and acitretin is one of the systemic agents that can be used to treat it [1,2,3]. Other than teratogenicity and other well-known side effects, including hepatotoxicity and mucocutaneous adverse reactions [4], acitretin is known as one of the most common causes of drug-induced nail pyogenic granuloma [5].…”

Highly Resistant Acrodermatitis Continua of Hallopeau and Pustular Psoriasis

“…Reports of a Lebanese family with a common IL-36RN mutation presenting as both ACH and GPP raises questions as to the epigenetic or environmental cues that may result in different phenotypes [2], progression from one to the other [5], or manifestations of both, as seen in our case. It is also unclear why, if the conditions are related, such contrasting responses to treatment are seen within the same individual and why long-term remission often remains elusive [6]. While secondary infection of the nailbed can occur in ACH, it is not known to contribute to the activity of disease.…”