Long-Term Control with Etanercept (Enbrel®) of a Severe Acrodermatitis Continua of Hallopeau Refractory to Infliximab (Remicade®)

Abstract

Hallopeau’s acrodermatitis is characterized by the presence of aseptic pustules on an inflammatory basis of the periungual or subungual region. The cyclic recurrences induce important physical and psychological morbidity. By analogy to the efficacy of TNF-α antagonists in the treatment of generalized pustular psoriasis, our patient illustrates the long-term efficacy and safety of etanercept (Enbrel®) in the treatment of Hallopeau’s acrodermatitis refractory to infliximab (Remicade®). This treatment alternative should in consequence be considered in patients with a recalcitrant form of a potentially debilitating disease.

Treatment of Acrodermatitis Continua of Hallopeau with TNF-Blocking Agents: Case Report and Review

“…Apart from one recent report on the successful use of efalizumab [23], which is not available anymore, there have been reports of effective treatment with the biologic tumor necrosis factor α (TNF-α) antagonists infliximab [24,25,26], adalimumab [27,28,29] and etanercept [30,31,32,33,34,35]. In some of these cases, combination therapy with acitretin [27,30], methotrexate [28] or ciclosporin [28] has been used.…”

“…In 5 previously published cases, ACH has been controlled by etanercept, either in combination with acitretin [30] or alone [31,32,33,34,35]. The reported effective doses of etanercept have been 25 mg twice a week [30,34,35] and 50 mg twice a week [31,32,33]. The effect of etanercept treatment has been apparent within weeks and maintained for the duration of treatment, even in 1 patient with refractory ACH that had been treated with infliximab with disappointing results [35].…”

“…The reported effective doses of etanercept have been 25 mg twice a week [30,34,35] and 50 mg twice a week [31,32,33]. The effect of etanercept treatment has been apparent within weeks and maintained for the duration of treatment, even in 1 patient with refractory ACH that had been treated with infliximab with disappointing results [35]. As regards etanercept failures, in addition to the cases reported by Ryan et al [28], there is a report on a 40-year-old man with ACH refractory to multiple treatments who was treated with etanercept 50 mg twice weekly for 12 weeks but failed to show a response [36], and a mention of 1 patient with severe ACH who failed to respond to etanercept (dose not stated) [33].…”

Un œdème inflammatoire des orteils récidivant

“…Il associe des traitements locaux (dermocorticoïdes, tacrolimus, calcipotriol, fluorouracil) et généraux (acitrétine, prednisolone, méthotrexate, colchicine, ciclosporine, photothérapie) avec une efficacité variable. Plus récemment, les anti-TNF alpha [9][10][11] ont montré leur efficacité dans quelques cas réfractaires.…”

Increased Serum Levels of Growth-Related Oncogene-α in Patients with Generalized Pustular Psoriasis

“…Also, TNF-␣ and IL-1 ␤ stimulate GRO-␣ gene expression, which may be related to enhanced levels of GRO-␣ in patients with GPP. Recent reports have shown that blockade of TNF-␣ is effective in the treatment of pustular psoriasis [8][9][10] and acrodermatitis continua of Hallopeau [11] . In correlation with the rapid improvement of GPP by anti-TNF-␣ therapy, various leukocyte populations infiltrating into the skin were significantly decreased [10] .…”