Acrodermatitis continua of Hallopeau

Acrodermatitis continua of Hallopeau, which is also known as “pustular acrodermatitis”, “Acrodermatitis perstans”,or “Dermatitis repens” is a rare, chronic, recurrent pustular eruption involving the fingers and toes.

The cause of Acrodermatitis continua of Hallopeau is still unknown. As it resembles the similar histologic features as pustular psoriasis, many consider it as a variant of pustular palmoplantar psoriasis. It is most common in middle-aged women and usually starts after localized infection or trauma on finger or toe. Later it may extend into generalized form during the chronic course of disease.

Initially, it may involve a distal one or two digits. Further, when disease progress it may be generalized over hands, forearm and foot. The skin over the lesion may be red and scaly and multiple pustules may develop. The lesion can be very painful and disabling. Involvement of nail bed and nail matrix often leads to nail dystrophy.

Treatment of Acrodermatitis continua is often difficult and there is no established treatment regimen. Because of its histopathologic similarity to pustular psoriasis, several psoriasis treatment modalities (topical and systemic ) have been tried. Topical treatment options include topical corticosteroids, tar, 5-fluorouracil, calcipotriol, racrolimus and dithranol. Systemic treatment options include oral retinoids, corticosteroids and other immunomodulating and immunosupressing drugs like cyclosporine, methotrexate, colchine, infliximab, dapsone, sulphasalazine, and PUVA photochemotherapy.

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