Treatment of acrodermatitis continua of Hallopeau with TNF-blocking agents: case report and review.
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.
Puig
Lluís
L
Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. lpuig@santpau.cat
Barco
Didac
D
Vilarrasa
Eva
E
Alomar
Agustín
A
D017255:Acitretin / Q000627:therapeutic use; D000169:Acrodermatitis / Q000188:drug therapy*; D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001623:Betamethasone / Q000627:therapeutic use; D002990:Clobetasol / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009262:Nails / Q000187:drug effects / Q000473:pathology; D010304:Paronychia / Q000188:drug therapy; D011565:Psoriasis / Q000188:drug therapy; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D000079424:Tumor Necrosis Factor Inhibitors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000079424:Tumor Necrosis Factor Inhibitors; D016572:Cyclosporine; D001623:Betamethasone; D002990:Clobetasol; D000068879:Adalimumab; D009173:Mycophenolic Acid; D017255:Acitretin; D000068800:Etanercept; D008727:Methotrexate