Apremilast as a new treatment option for Acrodermatitis continua of Hallopeau

Calleja‐Algarra, Alba; Miguel, Raquel Aragón; Velasco‐Tamariz, Virginia; Prieto‐Barrios, Marta; Lencina, Juan José Andrés; Alonso, Carolina Mancho; Romero, Pablo Luis Ortiz; Díaz, Raquel Rivera

doi:10.1111/ajd.12990

Cited by 12 publications

(17 citation statements)

References 6 publications

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“…2 Most recently, a growing number ofmostly successfultreatment experiences with biologics targeting tumor necrosis factor (TNF)-a, interleukin (IL)-17 or IL-(12)/23 and new small molecules (phosphodiesterase type 4 inhibitor) approved for plaque type psoriasis have been published. 2,7,8,[11][12][13][14][15][16][17][18][19] A recent review suggests a treatment algorithm starting with topical glucocorticoids under occlusion as first-line therapy, escalating to either cyclosporin, acitretin, adalimumab, etanercept, infliximab or ustekinumab as first-line systemic treatment, followed by systemic glucocorticoids, methotrexate or photo (chemo)therapy as second-line systemic therapies. 20 However, there is no clear recommendation which of the first-line systemic therapies to begin with.…”

Section: Introductionmentioning

confidence: 99%

“…42 Due to low efficacy, we do not recommend the use of fumaric acid esters or apremilast to control ACH symptoms based on our experience. For apremilast, individual case reports showed a good efficacy on ACH, 11,18,19 while therapy failure of apremilast is mentioned in other reports as ineffective prior therapy only when a positive treatment effect of another drug is described. 13,15 Our data suggests that biologics may be of use for clinicians in managing ACH as second-line treatment.…”

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confidence: 99%

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Treatment of acrodermatitis continua of Hallopeau: A case series of 39 patients

Kromer

Loewe

Schaarschmidt

et al. 2020

The Journal of Dermatology

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Acrodermatitis continua of Hallopeau (ACH) is a rare chronic inflammatory skin disease. Treatment is extremely challenging and mostly based on empirics as there is only scarce evidence from case reports and few small case series. In this retrospective study, patients with ACH treated at five university medical centers were analyzed according to patient and disease characteristics and treatment experience. We identified 39 patients with ACH with a mean age of 54.4 years at onset, of whom 22 (56.4%) were female. A total of 115 systemic treatment courses were analyzed with methotrexate as the most common therapy (27.0%). Overall, effectiveness of systemic treatments was low (excellent response rate: 14.8%). Among non‐biologics, excellent response was noted in 21.1% (4/19) of treatment courses with methotrexate, followed by acitretin (13.3%; 2/15). Among biologics, guselkumab (excellent response: 100%; 2/2), secukinumab (excellent response: 42.9%; 3/7) and adalimumab (excellent response: 20.0%; 2/10) were most efficacious. The median drug survival was 7.0 months and did not differ significantly between the subgroup of non‐biologic and biologic therapies. To our knowledge, this is the largest case series in ACH investigating patient characteristics and treatment outcomes. Based on our treatment experience, we suggest a treatment algorithm starting with acitretin or methotrexate as first‐line therapy, followed by biologics. Cyclosporin may be used for short‐term control. However, none of the applied systemic therapies yielded satisfying efficacy in our cohort. In patients with primary non‐response, switch of treatment should be evaluated timely on an individual basis, considering possible irreversible disease complications such as nail loss. More research with prospective design is needed to further evaluate traditional and also particularly newer antipsoriatic drugs in ACH.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Treatment of acrodermatitis continua of Hallopeau: A case series of 39 patients

Kromer

Loewe

Schaarschmidt

et al. 2020

The Journal of Dermatology

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“…Weight loss and depression have also been reported, but they do not usually require discontinuation of the therapy as these side effects can be solved or reduced simply by lowering the dose. There is just another case in literature of ACH successfully treated with Apremilast (Calleja‐Algarra, Aragón‐Miguel, & Velasco‐Tamariz, ). However, that patient did not reach a complete recovery as our patient did, after just 1 month.…”

Section: Discussionmentioning

confidence: 99%

Nails as immune‐privileged sites: A case of disabling Acrodermatitis continua of Hallopeau successfully treated with Apremilast

Lanna

Cesaroni

Mazzilli

et al. 2019

Dermatologic Therapy

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Acrodermatitis continua of Hallopeau (ACH) is a chronic, inflammatory, and relapsing disorder characterized by the progressive destruction of fingernails and toenails. This condition is rare, difficult to treat, and often misdiagnosed. Several antipsoriatic treatments have been used, without any therapeutic guideline and no real improvement. Apremilast is an oral phosphodiesterase 4 inhibitor, approved for the treatment of chronic plaque psoriasis and psoriatic arthritis. It increases the intracellular concentration of cAMP and restores cytokine equilibrium, especially IL‐10, which is particularly involved in nail psoriasis. We reported the case of a 58‐year‐old man affected by ACH, successfully treated with Apremilast, who achieved a complete healing in just 1 month of treatment without any side effect. We suggest this drug as a successful new treatment for ACH, which can improve clinical manifestations rapidly and has no or few adverse effects. Future formal clinical trials and additional case reports are needed to establish the safety and efficacy of Apremilast in the treatment of ACH.

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“…2,3 Apremilast is a relatively safe and easily administrable agent compared with biologics; its efficacy and safety for psoriasis and palmoplantar psoriasis have also been demonstrated. 4 Very recently, Calleja Algarra et al 5 reported apremilast as a new treatment option for ACH for the first time. To the best of our knowledge, the present case is the second to be reported showing the efficacy of apremilast on ACH.…”

Section: Successful Treatment Of Acrodermatitis Continua Of Hallopeaumentioning

confidence: 99%