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

Abstract

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.

Drug survival in the treatment of generalized pustular psoriasis: A retrospective multicenter study

“…Overall, drug survival in our patients was 14.0 months, which is higher than drug survival of systemic medication in the treatment of PPP patients (median: 8.0 months 21 ) and of ACH patients (median: 7.0 months 32 ), and comparable to PsO patients (median: 14 months 21 ). In contrast, Kishimoto and colleagues identified GPP compared with PsO as predictor for drug discontinuation with biologicals with a HR of 1.87 in Japan 22 .…”

Successful therapy of acrodermatitis continua of Hallopeau with IL‐23 blockers –two new cases

“…To the best of our knowledge, two cases where ACH was treated with guselkumab, published in the case series by our study group, are the only cases described so far in which interleukin (IL)-23 blockers were used [4]. They showed an excellent response, but the mean observation period was only ten months [4].…”

“…To the best of our knowledge, two cases where ACH was treated with guselkumab, published in the case series by our study group, are the only cases described so far in which interleukin (IL)-23 blockers were used [4]. They showed an excellent response, but the mean observation period was only ten months [4]. Here we report two new cases of ACH that were successfully treated with IL-23 inhibitors, and with cases 3 and 4 we provide details and follow-up on the two patients who till now have only been summarily described [4].…”

Skin manifestations in spondyloarthritis

“…The treatment of all pustular PsO types is challenging and there is a need for treatments with proven efficacy. [38][39][40] IBD-associated skin manifestations in spondyloarthritis Crohn's disease (CD) and ulcerative colitis (UC) are chronic IBDs, which can present with several extra intestinal manifestations (EIM) that affect mortality and morbidity. Up to 50% of IBD patients experience at least one EIM.…”