Acrodermatitis continua of Hallopeau

Acrodermatitis continua of Hallopeau (ACH), also known as acrodermatitis perstans or dermatitis repens, is a rare, chronic, and often treatment-resistant form of localized pustular psoriasis. It is classified under pustular psoriasis (ICD-10: L40.2) and is characterized by sterile (non-infectious) pustular eruptions that typically begin on the tips of the fingers and toes, often following local trauma or infection. The pustules recur persistently and can spread proximally along the digits and occasionally to other areas of the skin. The disease primarily affects the skin and nails of the distal extremities. Key clinical features include painful, sterile pustules on the fingertips and toes that dry and reform in a continuous cycle, leading to progressive nail dystrophy and eventual nail loss (anonychia). Over time, the chronic inflammation can cause atrophy of the underlying soft tissue and even osteolysis (bone resorption) of the distal phalanges, resulting in significant functional impairment and disability. The skin of affected digits becomes erythematous, glazed, and scaly. The condition can be extremely painful and debilitating, significantly impacting quality of life. Treatment of acrodermatitis continua of Hallopeau is challenging, as the condition is notoriously resistant to many therapies. Topical treatments including potent corticosteroids, calcipotriol, and tacrolimus may provide partial relief. Systemic therapies such as acitretin, methotrexate, and cyclosporine have been used with variable success. More recently, biologic agents targeting tumor necrosis factor-alpha (TNF-α inhibitors such as infliximab and adalimumab), interleukin-17 (secukinumab, ixekizumab), and interleukin-36 receptor (spesolimab) have shown promising results in refractory cases. Phototherapy (PUVA) and photodynamic therapy have also been reported as adjunctive options. Early and aggressive treatment is important to prevent irreversible nail and bone damage.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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