Background: Acrodermatitis continua of Hallopeau (ACH) is a rare form of pustular psoriasis that is clinically characterized by periungual subungual sterile pustules with paronychia, onychodystrophy, and osteolysis of the distal phalanx of the fingers, toes, and atrophic skin.
Objective: To review the clinical and histopathological features, treatment outcomes, and prognosis of patient with ACH.
Methods: We identified patients who were clinically or histologically diagnosed with ACH between 2006 to 2015 at the Youido St. Mary's Hospital using hospital charts. Clinical manifestations, aggravating factors, association with psoriasis, treatment, and prognosis were retrospectively evaluated.
Results: Overall, 16 patients (age range, 9∼61 years) were identified, including 13 women. All patients had subungual pustulosis with nail changes including onycholysis (69%), trachyonychia (69%), or yellowish chromonychia (44%). Two patients had additional psoriatic lesions on other body parts. Histopathological results of subungual biopsies performed in 9 patients showed acanthosis, inflammatory cell infiltrates, and pustular formation. Treatment included dapsone (69%), nonsteroidal anti-inflammatory drugs (63%), methotrexate (31%), and acitretin (13%). Eight patients were followed for more than 6 months. Among these, 87.5% required long-term treatment lasting longer than 6 months, and poor treatment response of ＜50% was seen in 62.5% of patients.
Conclusion: To our knowledge, this is the first study conducted in Korea to report the characteristics of ACH, including its epidemiology, lesion distribution, nail changes, exacerbation factors, presence of psoriasis, pathological features, treatment response, and duration. Future research is needed to confirm the effectiveness of treatment and develop treatment guidelines.
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