Acrodermatitis Continua of Hallopeau in a 47-Year Old Filipino Female Treated with Topical Corticosteroids and Systemic Methotrexate

Abstract

Acrodermatitis continua of Hallopeau (ACH) is a rare pustular type of psoriasis with poorly understood pathophysiology characterized by chronic, sterile pustules on the fingers and toes with nail dystrophy and possible anonychia. No drug has thus far successfully achieved lasting remission. This case reports a 47-year old Filipino female who presented with multiple pustules on the fingers and toes of 32 years duration associated with pain, all unresponsive to oral antibiotics and analgesics. Gradual development of erosions, fissures, and scales were noted on all digits as well as intermittent join pain and swelling and nail disruption on the affected fingers with eventual anonychia. Radiography showed shortening of the distal phalanges on the first to third digits on both hands; and histopathology revealed psoriasiform dermatitis. The patient was started on twice daily clobetasol propionate ointment and oral methotrexate at 10mg/week for 3 weeks, subsequently increased to 15mg/week for 7 weeks, reaching a cumulative dose of 135mg, achieving resolution of most of the pustules with no new lesions noted. Erythema and scaling decreased while pain resolved. At 10 weeks of treatment, the patient presented with minimal pustules, erythema and dry residual scaling on all digits. ACH is a rare pustular type of psoriasis with epidemiologic data limited to anecdotal case reports. Furthermore, despite the lack of established management guidelines, several case reports have shown improvement with some available treatment options, including the ones employed in this case.