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Acrodermatitis Continua of Hallopeau


Presentation

  • We present a 63-year-old Japanese woman who had clinically unique symmetrical skin rashes on her lower face, inframammary area, back and extremities, with some pustules on the cheeks.[ncbi.nlm.nih.gov]
  • It often presents at the nail folds of one or two fingers and then extends to others. Sometimes it remains in only one finger and that makes the diagnosis difficult. We present such a case.[epostersonline.com]
  • Here, we present a case of a 45-year-old female who presented with multiple pustules pathologically diagnosed as pustular psoriasis on her left thumb.[yonsei.pure.elsevier.com]
Soft Tissue Swelling
  • On radiological examination, there was focal soft tissue swelling at the tips of fingers of both hands with irregular outline and fissure-like indentation.[ncbi.nlm.nih.gov]
Joint Tenderness
  • Within 4 months, there was near complete resolution of skin and nail changes as well as relief of joint tenderness and swelling ( Figure 1C ). Figure 1. Acrodermatitis continua of Hallopeau. A. At presentation. B. After acitretin for 10 months.[jrheum.org]

Workup

  • A negative workup for aerodigestive malignancy indicated that it was unlikely Bazex disease. She had negative testing on two occasions for connective tissue disease.[journals.sagepub.com]
  • Most investigative workup recommended is largely for exclusion of other dermatoses.[ijpd.in]
Mycobacterium Fortuitum
  • The left great toe was amputated in September 2008 on suspicion of osteomyelitis due to persistent positive culture specimens for Mycobacterium fortuitum despite antibiotic therapy with cephalexin, flucloxacillin, and a 6-month course of doxycycline ([karger.com]

Treatment

  • By analogy to the efficacy of TNF-α antagonists in the treatment of generalized pustular psoriasis, the two patients we report illustrate the long-term efficacy and safety of adalimumab in the treatment of  Hallopeau's acrodermatitis refractory to therapies[ncbi.nlm.nih.gov]

Prognosis

  • What is the prognosis ? Acrodermatitis continua of Hallopeau is a chronic disease that may eventually destroy the nail and underlying bone as described above.[dermnetnz.org]
  • G.P.P. developing from acral pustulosis (acrodermatitis continua) has the worst prognosis and is likely to prove fatal.[doi.org]
  • PH is a rare form of pemphigus vegetans and it has a better prognosis with 1% to 2% of spontaneous remission [3] . It is also considered as an infectious disease [4] or as a disease associated with inflammatory enterocolitis [5] .[scirp.org]
  • Prognosis The condition tends to be chronic and poorly responsive to treatment [ 1 ] .[patient.info]
  • It has a benign and non-mutilating clinical course and prognosis is good. The onset is insidious and it usually regresses as the child grows up.[ijpd.in]

Etiology

  • Little is known about its etiology or relative effectiveness of the various therapeutic approaches. However, in the literature a pattern seems to be developing on successfully treated patients using biologic therapies.[ncbi.nlm.nih.gov]
  • The exact etiology is unknown. Mutations in the IL36RN gene have been associated with the development of ACH and pustular psoriasis. ACH often has a chronic, relapsing course.[visualdx.com]
  • Take Quiz Treatment of actinic keratosis Take Quiz Actinic keratosis: Epidemiology & etiology Take Quiz Quiz Patch testing for adverse drug reactions Take Quiz Quiz Atopic dermatitis: Persistence of disease Take Quiz The skin & climate change Take Quiz[mdedge.com]
  • Various investigations provided no real clue to the etiology, but there was a relatively high incidence of seborrheic dermatitis. In contrast to adult patients, in only 12% was there a prior history of psoriasis vulgaris.[doi.org]

Epidemiology

  • Take Quiz Treatment of actinic keratosis Take Quiz Actinic keratosis: Epidemiology & etiology Take Quiz Quiz Patch testing for adverse drug reactions Take Quiz Quiz Atopic dermatitis: Persistence of disease Take Quiz The skin & climate change Take Quiz[mdedge.com]
  • A clinical and epidemiological study of 104 cases. Br J Dermatol. 1968; 80 :771–93. [ PubMed ] [ Google Scholar ] 2. Xiao T, Li B, He CD, Chen HD. Juvenile generalized pustular psoriasis. J Dermatol. 2007; 34 :573–6. [ PubMed ] [ Google Scholar ] 3.[ncbi.nlm.nih.gov]
  • Murphy, The epidemiology of childhood psoriasis: a scoping review, British Journal of Dermatology, 174, 6, (1242-1257), (2016).[doi.org]
  • A number of pustular skin diseases share clinical, pathogenetic, and epidemiological aspects with plaque-type psoriasis, and their classification as a separate clinical entity or as a subtype of psoriasis remains controversial, which is also reflected[gulfdoctor.net]
  • Epidemiology The condition is rare in Europe but more common in the East [ 6 ]. It occurs much more commonly in smokers and ex-smokers. It may run in families and rarely occurs in childhood.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • This paper provides an extremely current and robust review of therapeutic options and discusses proposed pathophysiologic mechanisms in detail.) Ryan, C, Collins, P, Kirby, B, Rogers, S.[dermatologyadvisor.com]
  • It is considered a variant of pustular psoriasis or, less commonly, its own pustular psoriasis-like independent entity. 1 Precise pathophysiology and incidence are unknown.[jamanetwork.com]
  • Disease burden & QOL in psoriasis patients Take Quiz Psoriasis & risk of depression Take Quiz Understanding patient-reported experiences of living with psoriasis Take Quiz Psoriasis treatment: Part 2 Take Quiz Systemic therapies for psoriasis Take Quiz Pathophysiology[mdedge.com]
  • Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckland, NZ). 2016;6:131-144. Tosti A, Piraccini B. Nail disorders. In: Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th edition.[clinicaladvisor.com]
  • Female predominance Predominantly in adults but also seen in children: observed in 4.7% cases of infantile psoriasis in one series Etiology and Pathophysiology Immune dysregulation: Acute-phase reactants such as IL-1 and IL-36 likely play a role in pathogenesis[unboundmedicine.com]

Prevention

  • Take Quiz Sunburn and solar erythema Take Quiz Rare types of melanoma Take Quiz Prevention and detection of melanoma on the back Take Quiz CDC report: Melanoma incidence Take Quiz Incidence of BCC Take Quiz Health concerns associated with sunscreen use[mdedge.com]
  • The regular application of an emollient can help prevent skin from cracking and keep the palms and soles more supple.[papaa.org]
  • For recalcitrant patients, anecdotal reports also recommend dapsone and nimesulide to prevent relapses.[dermatologyadvisor.com]
  • Is there any diet I can follow that will help prevent a flare? A: At this time, there are no known diets that can prevent a flare.[medicalnewstoday.com]
  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[doi.org]

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