Acrodermatitis Continua Suppurativa

 

 

 Hallopeau

 

Acrodermatitis continua of Hallopeau, which was also known as dermatitis repens, is a rare, chronic, localized, sterile pustular eruption of the fingers and toes. [1] Although it is generally considered to be a variant of pustular psoriasis, some individuals classify it as a separate entity. [2] It is most common in middle-aged women and often begins after localized trauma or infection on a single digit. [1]

Acrodermatitis continua, which is characterized by multiple pustules with scale on an erythematous base, is usually restricted to a distal location on one or two digits. The pustules may coalesce to form lakes of pus, and, over time, they may spread proximally to involve the dorsal aspects of the hands, forearms, and feet. Pustulation of the nail bed and nail matrix often is associated with onychodystrophy and even anonychia of the involved digits. Over time, some patients will develop osteolysis of the distal phalanx that underlies the eruption. [1]

Histologically, acrodermatitis continua displays features of pustular psoriasis that include subcorneal neutrophilic pustules. [1] This disorder is easily misdiagnosed as bacterial or fungal paronychia, owing to its chronic purulent discharge; other entities in the differential diagnosis include allergic contact dermatitis and dyshidrotic eczema.

Acrodermatitis continua can be resistant to treatment. It may be treated topically with glucocorticoids, calcipotriene, or 5-fluorouracil. Systemic treatments include oral retinoids, cyclosporine, methotrexate, and PUVA photochemotherapy