engleski

A therapy resistant case of acrodermatitis continua of Hallopeau in an adult male patient

Acrodermatitis continua of Hallopeau (ACH), also known as acropustulosis, is a rareform of pustular psoriasis. It presents as a chronic, inflammatory eruption with sterile pustules, erythema, and hyperkeratosis on thetip of one or more digits. It typically occurs following local trauma or infection.The diseaseis difficult to treatand can result in irreversiblecomplications ranging from anonychia to osteolysis of the distal phalanx.We presenta case of a 61- year-old male patient with painful coalescing pustules “lakes of pus” with surrounding erythema and crusting on the distal phalanx of theleft index finger.The nail was dystrophic, and the nail bed was studded with pustules.The lesions were present for fiveyears in a waxing and waning manner prior to his hospital visit, and patient history failed to reveal any possiblecause.There was also no family history of psoriasis. However, the patient did report that hesought professional help on several occasions when theskin lesions initially appeared. At that time, a diagnosis of fingertip eczema was suspected, and allergy skin testing was performed to exclude potential causative agents. Patch testing was positivefor neomycin sulphateand thimerosal. He was treated with topical antibiotic, corticosteroid and antimycotic creams without significant improvement, and at that point, the patient was lostat follow-up. It was dueto the persistentand progressive nature of his diseasethat the patient was referred to our departmentafter a three-year gap. Complete diagnostic work-up was conducted. Routinelaboratory tests were unremarkable.Wound swabs revealed a secondary infection with Klebsiella aerogenes which was subsequently treated with systemic combination antibiotic therapy. Radiography of theaffected finger and hand was conducted in order to exclude underlying osteitis and osteolysis of the phalanxalong with any other signs of jointassociation. Histopathology revealed spongiform pustules of Kogoj in the upper dermis along with a lympho- histiocytic infiltrateand focal edema suggestive of pustular psoriasis. Based on theclinico-histopathological correlation, the patient was diagnosed ACH. Weinitiated treatment with an oral retinoid, acitretin, but the patient demonstrated minimal improvement on a daily dose of 20 mg whileexperiencing severe gastrointestinal symptoms, abdominal pain and vomiting preventing doseincrease. Hereafter, treatment with an oral phosphodiesterase-4 inhibitor, apremilast, with a dose of 30 mg twice daily, was introduced. However, diseasecontrol was notachieved, and apremilast was stopped after 12 weeks. Dueto insufficient diseasecontrol and secondary skin atrophy associated with anonychia we decided to switch to interleukin-23 inhibitor risankizumab administered subcutaneously ata dose of 150 mg every 12 weeks after two initiation doses one month apart. As of last follow-up the patient has received three doses with significant pain reduction but slight clinical improvement.Further follow-up is necessary in order to evaluatetreatmentefficacy. ACH is a rareform of pustular psoriasis. Dueto the generally ineffectivetreatment modalities and chronic progressive nature, ACH significantly influences patients’ everyday living and quality of life. However, thereis a need for targeted research sincethereare no randomized controlled studies to evaluatetherapies and in turn no standardized treatment guidelines.

Acrodermatitis continua of Hallopeau, therapy, risankizumab

nije evidentirano