Successful treatment of acrodermatitis continua of Hallopeau with apremilast

Kurihara, Yusuke; Nakano, Kazuhisa; Eto, Ayaka; Furue, Masutaka

doi:10.1111/1346-8138.14927

Cited by 8 publications

(10 citation statements)

References 5 publications

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“…Topical treatments (i.e., corticosteroids, calcipotriol, tacrolimus, and fluorouracil, or a combination of these drugs) have a limited efficacy and alternative treatments are often necessary. These include cyclosporine, systemic corticosteroids, retinoids, methotrexate, PUVA, UVB phototherapy, GMA, and biologic agents (e.g., anti-TNF agents, IL-17 inhibitors, IL-12/23 inhibitors, and anakinra) [ 53 , 55 , 170 ] and also apremilast and baricitinib [ 175 , 176 ].…”

Section: Treatmentmentioning

confidence: 99%

Pustular Psoriasis: From Pathophysiology to Treatment

Genovese

Moltrasio

Cassano³

et al. 2021

Biomedicines

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Pustular psoriasis (PP) is a clinicopathological entity encompassing different variants, i.e., acute generalized PP (GPP), PP of pregnancy (impetigo herpetiformis), annular (and circinate) PP, infantile/juvenile PP, palmoplantar PP/palmoplantar pustulosis, and acrodermatitis continua of Hallopeau (ACH), which have in common an eruption of superficial sterile pustules on an erythematous base. Unlike psoriasis vulgaris, in which a key role is played by the adaptive immune system and interleukin (IL)-17/IL-23 axis, PP seems to be characterized by an intense inflammatory response resulting from innate immunity hyperactivation, with prominent involvement of the IL-36 axis. Some nosological aspects of PP are still controversial and debated. Moreover, owing to the rarity and heterogeneity of PP forms, data on prognosis and therapeutic management are limited. Recent progresses in the identification of genetic mutations and immunological mechanisms have promoted a better understanding of PP pathogenesis and might have important consequences on diagnostic refinement and treatment. In this narrative review, current findings in the pathogenesis, classification, clinical features, and therapeutic management of PP are briefly discussed.

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Section: Treatmentmentioning

confidence: 99%

Pustular Psoriasis: From Pathophysiology to Treatment

Genovese

Moltrasio

Cassano³

et al. 2021

Biomedicines

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“…2 Most recently, a growing number ofmostly successfultreatment experiences with biologics targeting tumor necrosis factor (TNF)-a, interleukin (IL)-17 or IL-(12)/23 and new small molecules (phosphodiesterase type 4 inhibitor) approved for plaque type psoriasis have been published. 2,7,8,[11][12][13][14][15][16][17][18][19] A recent review suggests a treatment algorithm starting with topical glucocorticoids under occlusion as first-line therapy, escalating to either cyclosporin, acitretin, adalimumab, etanercept, infliximab or ustekinumab as first-line systemic treatment, followed by systemic glucocorticoids, methotrexate or photo (chemo)therapy as second-line systemic therapies. 20 However, there is no clear recommendation which of the first-line systemic therapies to begin with.…”

Section: Introductionmentioning

confidence: 99%

“…42 Due to low efficacy, we do not recommend the use of fumaric acid esters or apremilast to control ACH symptoms based on our experience. For apremilast, individual case reports showed a good efficacy on ACH, 11,18,19 while therapy failure of apremilast is mentioned in other reports as ineffective prior therapy only when a positive treatment effect of another drug is described. 13,15 Our data suggests that biologics may be of use for clinicians in managing ACH as second-line treatment.…”

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confidence: 99%

Treatment of acrodermatitis continua of Hallopeau: A case series of 39 patients

Kromer

Loewe

Schaarschmidt

et al. 2020

The Journal of Dermatology

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Acrodermatitis continua of Hallopeau (ACH) is a rare chronic inflammatory skin disease. Treatment is extremely challenging and mostly based on empirics as there is only scarce evidence from case reports and few small case series. In this retrospective study, patients with ACH treated at five university medical centers were analyzed according to patient and disease characteristics and treatment experience. We identified 39 patients with ACH with a mean age of 54.4 years at onset, of whom 22 (56.4%) were female. A total of 115 systemic treatment courses were analyzed with methotrexate as the most common therapy (27.0%). Overall, effectiveness of systemic treatments was low (excellent response rate: 14.8%). Among non‐biologics, excellent response was noted in 21.1% (4/19) of treatment courses with methotrexate, followed by acitretin (13.3%; 2/15). Among biologics, guselkumab (excellent response: 100%; 2/2), secukinumab (excellent response: 42.9%; 3/7) and adalimumab (excellent response: 20.0%; 2/10) were most efficacious. The median drug survival was 7.0 months and did not differ significantly between the subgroup of non‐biologic and biologic therapies. To our knowledge, this is the largest case series in ACH investigating patient characteristics and treatment outcomes. Based on our treatment experience, we suggest a treatment algorithm starting with acitretin or methotrexate as first‐line therapy, followed by biologics. Cyclosporin may be used for short‐term control. However, none of the applied systemic therapies yielded satisfying efficacy in our cohort. In patients with primary non‐response, switch of treatment should be evaluated timely on an individual basis, considering possible irreversible disease complications such as nail loss. More research with prospective design is needed to further evaluate traditional and also particularly newer antipsoriatic drugs in ACH.

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“…4 Another pediatric ACH case showing a slight improvement after 1 month of acitretin (discontinued for cholesterol elevation) was successfully treated with thalidomide and UVB therapy. 5 While both biologics and small molecules have been used with promising results in adult ACH patients, 6,7 experience of biological treatments in pediatric ACH is still poor.…”

mentioning

confidence: 99%