Immuno-dermatology

Poster

Case Report: Acrodermatitis Continua of Hallopeau (ach) with Acro-osteolysis Progressing to Generalized Pustular Psoriasis

Wednesday, June 14
6:15 PM - 7:45 PM

Introduction: Acrodermatitis Continua of Hallopeau (ACH) is a recurrent painful form of localized pustular psoriasis occurs on the fingertips and nail folds mainly in females. In each episode only one or two digits are involved. It may be associated with nail disorders, distal phalangeal atrophy and osteolysis. Rarely ACH progresses to generalized pustular psoriasis (GPP) in elderly.


Case presentation: We present a 63-year-old woman with painful pustular lesions on three fingertips, great toes tips and plantar areas which became gradually generalized after a febrile attack and discontinuing oral retinoid. She had no distal phalanx on the right index finger. Other distal phalanxes were atrophic with onychodystrophy and deformed interphalangeal joints. The first episode of ACH occurred during pregnancy, 40 years ago but sequential episodes happened afterwards. She had geographic tongue and ear cholesteatoma. Laboratory data showed elevated erythrocyte sedimentation rate, leukocytosis, positive C-reactive protein, bacteriuria with positive culture. Imaging showed acro-osteolysis and right index distal phalangeal bone absorption. Biopsy confirmed pustular psoriasis. She was treated with methotrexate, acitretin and ciprofloxacin.


Discussion: ACH is a rare and recalcitrant type of pustular psoriasis. Trauma, infection, steroid withdrawal, sun light, stress, hypocalcemia and pregnancy are inducing factors. Interleukin 36RN gene mutations have a pathogenic role in pustular eruptions including ACH, palmoplantar pustulosis and acute GPP which explain this co-occurrence.


Conclusion: ACH is treatment resistant but therapies should be considered as soon as possible. Early management may prevent progressive disabilities. Better understanding of pathogenesis of GPP might bring new treatments such as biologic agents.

Rana Rafiei

Assistant professor of Dermatology, Fellow ship of Dermatopathology
Guilan University of Medical Sciences, Razi Hospital

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    Behnam Rafiee

    n/a

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      Sara Naji Rad

      Resident Physician
      Nassau University Medical Center

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        Alireza Mesbah

        Anatomical and clinical pathologist
        Guilan University of Medical Sciences, Razi Hospital

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          Case Report: Acrodermatitis Continua of Hallopeau (ach) with Acro-osteolysis Progressing to Generalized Pustular Psoriasis



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