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

Saunier, Jordane; Debarbieux, S.; Jullien, D.; Garnier, L.; Dalle, S.; Thomas, Luc

doi:10.1159/000367690

Cited by 23 publications

(36 citation statements)

References 27 publications

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“…Similar to our experience with our patient, almost all the antipsoriatic agents have been used in the treatment of ACH, and current literature shows <50 cases that were treated with anti-TNF-a agents (Adışen et al, 2007;Di Costanzo et al, 2014;Dini, Barbanera, & Romanelli, 2013;Lutz & Lipsker, 2012;Puig et al, 2010;Rubio, Martin, Arranz S anchez, Vidaurrazaga, & Casado, 2009;Ryan et al, 2009;Saunier et al, 2015;Sehgal et al, 2011;Thielen, Barde, Marazza, & Saurat, 2008;Tobin & Kirby, 2005). Numerous cases of ACH, but not all (Adışen et al, 2007;Lutz & Lipsker, 2012), have been reported to respond to etanercept, to infliximab, or to adalimumab, either in combination with acitretin FIG URE 1 Initial use ustekinumab; Hyperkeratotic erythematous plaques with pustules on the dorsal and ventral aspects of all fingers (a, b), an excellent response was observed after three doses of ustekinumab treatment (c, d) or monotherapy (Di Costanzo et al, 2014;Dini et al, 2013;Lutz & Lipsker, 2012;Puig et al, 2010;Rubio et al, 2009;Ryan et al, 2009;Saunier et al, 2015;Sehgal et al, 2011;Thielen et al, 2008;Tobin & Kirby, 2005). In accordance with the concept that failure of response to one anti-TNF-a antagonist does not preclude the use of another anti-TNF-a agent, cases resistant to infliximab responded to adalimumab (Tobin & Kirby, 2005) or resistant to etanercept responded to adalimumab (Dini et al, 2013;Ryan et al, 2009) or to infliximab (Thielen et al, 2008).…”

Section: Discussionsupporting

confidence: 85%

“…In accordance with the concept that failure of response to one anti‐TNF‐α antagonist does not preclude the use of another anti‐TNF‐α agent, cases resistant to infliximab responded to adalimumab (Tobin & Kirby, ) or resistant to etanercept responded to adalimumab (Dini et al, ; Ryan et al, ) or to infliximab (Thielen et al, ). In some patients such as ours, the disease takes a more severe chronic course recalcitrant to all anti‐TNF‐α agents (Lutz & Lipsker, ; Saunier et al, ). Apart from ours, there are two other ACH patients that have been improved with the ustekinumab treatment (Cymerman & Cohen, ; Saunier et al, ).…”

Section: Discussionmentioning

confidence: 94%

“…In some patients such as ours, the disease takes a more severe chronic course recalcitrant to all anti‐TNF‐α agents (Lutz & Lipsker, ; Saunier et al, ). Apart from ours, there are two other ACH patients that have been improved with the ustekinumab treatment (Cymerman & Cohen, ; Saunier et al, ).…”

Section: Discussionmentioning

confidence: 94%

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Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Adışen

Özer

Temel

et al. 2017

Dermatologic Therapy

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Acrodermatitis continua of Hallopeau (ACH) is a variant of pustular psoriasis that is often very difficult to treat. Almost all anti-psoriatic agents have been used in the treatment of ACH. Ustekinumab, a fully human monoclonal antibody of the IgG1 class, is directed to the shared p40 subunit of cytokines IL-12 and IL-23. Herein, we present our experience of ustekinumab use in a 50-year-old man who was resistant to anti-tumor necrosis factor-α agents. Though initial therapy with ustekinumab achieved a sustained response in our patient, after a seven months of interruption, retreatment resulted in a slower and poorer response than the initial regimen. Both responses of our patient reflects: (i) the recalcitrant chronic nature of ACH in some patients, (ii) the value of ustekinumab in ACH treatment, (iii) the fact that, as with other biologics, a loss of response may also occur with ustekinumab when the treatment is interrupted. All these data provides evidence for the fact that the course of ACH is unpredictable and possibly indicate that concerning current biologics used in the treatment of ACH, we have still failed to hit the target we aimed for.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 94%

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Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Adışen

Özer

Temel

et al. 2017

Dermatologic Therapy

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“…Second-line treatment includes adalimumab, etanercept, alefacept or combination therapy [3]. Small studies and single cases have also reported other systemic medications such as anakinra and ustekinumab to be effective [3,4,13,14,15,39]. …”

Section: Discussionmentioning

confidence: 99%

Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Sheu¹,

Divito²,

Enamandram³

et al. 2015

Dermatology

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Background: Pustular psoriasis is an uncommon psoriasis variant, clinically characterized as small sterile pustules on an erythematous base. Evidence for therapy is lacking, and many currently employed systemic therapeutics carry risks of significant side effects, without specifically targeting disease etiology which includes the aggregation of neutrophils. Observations: We report therapy with the anti-neutrophil agent dapsone in 5 patients with pustular psoriasis and provide a brief review of the literature. Four patients responded to oral dapsone and 1 to topical dapsone therapy. All 5 patients had previously failed multiple topical and systemic treatments. In 2 cases, oral dapsone allowed for the discontinuation of other systemic agents. One patient stopped oral dapsone due to a side effect of sleep disturbance. Conclusion: Dapsone has a much safer side effect profile and may target the pathophysiology of pustular psoriasis more directly than many other systemic agents. As such, dapsone should be considered for the treatment of patients with pustular psoriasis.

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“…To our knowledge, 49 cases of ACH have been reported to be treated with biologics (14 with IFX, 13 with adalimumab, 12 with etanercept, 4 with ustekinumab, 3 with secukinumab, and 3 with efalizumab). Table summarizes the 14 reported cases of ACH treated with IFX . Among them, 8 cases were successfully treated with IFX; however, some reports described the failure of IFX to treat ACH.…”

Section: Discussionmentioning

confidence: 99%

Acrodermatitis continua of Hallopeau successfully treated only with infliximab: A case report

Kioka

Tanizaki

et al. 2018

J Cutaneous Imm & Allergy

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A 22-year-old man presented with a 2-month history of rapidly progressing pustular eruptions on the accrual regions of his fingers and toes with local arthralgia and severe nail destruction. A histological examination revealed parakeratosis, hyperkeratosis and elongation of the rete ridges of the epidermis with exocytosis of neutrophils forming spongiform pustules of Kogoj. Based on these findings, we diagnosed this case as acrodermatitis continua of Hallopeau (ACH). ACH, a variant of pustular psoriasis, is often resistant to various topical treatments, and the patient experienced prominent decline in his quality of life. Therefore, we decided to use infliximab in the present case. After the fourth administration of infliximab alone, the patient's digital arthralgia and pustular eruptions disappeared completely, and the long-term administration of infliximab drastically reduced all of the patient's symptoms of ACH, including the nail lesions without any adverse events or recurrence. Our findings suggest that ACH shares a disease spectrum with plaque-type and pustular psoriasis. In addition, biologic agents such as a tumor necrosis factor-a inhibitor are useful for treating patients with ACH just as those with psoriasis and may even be used alone. showing a prompt and long-term effect against the skin eruptions as well as the arthralgia and nail involvement over a period of 1 year.--

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

Cited by 23 publications

References 27 publications

Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Acrodermatitis continua of Hallopeau successfully treated only with infliximab: A case report

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