Acrodermatitis continua of Hallopeau successfully treated only with infliximab: A case report

Abstract

A 22‐year‐old man presented with a 2‐month history of rapidly progressing pustular eruptions on the accrual regions of his fingers and toes with local arthralgia and severe nail destruction. A histological examination revealed parakeratosis, hyperkeratosis and elongation of the rete ridges of the epidermis with exocytosis of neutrophils forming spongiform pustules of Kogoj. Based on these findings, we diagnosed this case as acrodermatitis continua of Hallopeau ( ACH ). ACH , a variant of pustular psoriasis, is often resistant to various topical treatments, and the patient experienced prominent decline in his quality of life. Therefore, we decided to use infliximab in the present case. After the fourth administration of infliximab alone, the patient's digital arthralgia and pustular eruptions disappeared completely, and the long‐term administration of infliximab drastically reduced all of the patient's symptoms of ACH , including the nail lesions without any adverse events or recurrence. Our findings suggest that ACH shares a disease spectrum with plaque‐type and pustular psoriasis. In addition, biologic agents such as a tumor necrosis factor‐α inhibitor are useful for treating patients with ACH just as those with psoriasis and may even be used alone.