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Case Report
Medwave 2020;20(8):e8021 doi: 10.5867/medwave.2020.08.8021
Acrodermatitis continua of Hallopeau and psoriatic arthritis: A case report
Carolina García, Javier Arellano, Valentina Vera, Yamile Corredoira
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Key Words: psoriasis, arthritis, psoriatic, acrodermatitis, nail diseases

Abstract

A 44-year-old man, previously healthy, consulted for a three-month history of asymmetrical polyarthralgia with inflammatory features involving small and large joints. A few days later, he developed erythema covered by pustules in the nail folds and progressive degeneration of the nail plate of the left thumb, with severe functional limitation. The physical exam showed well-defined erythematous scaly and pustular plaques in the first and third fingers of the left hand, with severe onychodystrophy, which was a key aspect in the diagnosis of acrodermatitis continua of Hallopeau. Other signs of the psoriatic spectrum were observed: erythematous patches of the scrotum, erythematous scaly plaques with hemorrhagic crusts on both knees, and dactylitis. The diagnosis of inverse psoriasis, plaque psoriasis, and pustular psoriasis, respectively, were confirmed by histopathology and, with the CASPAR criteria, psoriatic arthritis. This case is of particular dermatological interest due to the variety of psoriatic manifestations recognized in a single patient and because of the poorly described association between acrodermatitis continua of Hallopeau with psoriatic arthritis.


 

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Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Un hombre de 44 años, previamente sano, consultó por poliartralgias asimétricas de características inflamatorias de tres meses de evolución, que comprometió pequeñas y grandes articulaciones. Poco tiempo después desarrolló pústulas periungueales sobre una base eritematosa y degeneración progresiva de la lámina ungueal del pulgar izquierdo, limitando severamente su funcionalidad. Destacó al examen físico la presencia de placas eritemato-escamosas y pustulosas bien delimitadas en el primer y tercer dedo de la mano izquierda con onicodistrofia severa, que fue un aspecto clave para establecer el diagnóstico de acrodermatitis continua de Hallopeau. Adicionalmente, se observaron otros hallazgos del espectro psoriático: parches eritematosos en el escroto, placas eritemato-escamosas con costras hemorrágicas en ambas rodillas y dactilitis. Se confirmó histológicamente el diagnóstico de psoriasis inversa, psoriasis en placas y psoriasis pustular, respectivamente y con los criterios de Classification Criteria for Psoriatic Arthritis, CASPAR, el diagnóstico de artritis psoriática.

Authors: Carolina García[1], Javier Arellano[2,3], Valentina Vera[1], Yamile Corredoira[4]

Affiliation:
[1] Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
[2] Departamento de Dermatología, Universidad de Chile, Sede Centro, Santiago, Chile
[3] Servicio de Dermatología, Hospital Clínico San Borja-Arriarán, Santiago, Chile
[4] Departamento de Anatomía Patológica, Facultad de Medicina, Universidad de Chile, Santiago, Chile

E-mail: draveragiglio@gmail.com

Author address:
[1] Santos Dumont 999, Independencia
Santiago, Chile
Código postal: 8380456

Citation: García C, Arellano J, Vera V, Corredoira Y. Acrodermatitis continua of Hallopeau and psoriatic arthritis: A case report. Medwave 2020;20(8):e8021 doi: 10.5867/medwave.2020.08.8021

Submission date: 24/3/2020

Acceptance date: 28/8/2020

Publication date: 17/9/2020

Origin: No solicitado

Type of review: Con revisión por pares externa, por cuatro árbitros a doble ciego

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  1. Sehgal VN, Verma P, Sharma S, Srivastava G, Aggarwal AK, Rasool F, et al. Acrodermatitis continua of Hallopeau: evolution of treatment options. Int J Dermatol. 2011 Oct;50(10):1195-211. | CrossRef | PubMed |
  2. Navarini AA, Burden AD, Capon F, Mrowietz U, Puig L, Köks S, et al. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017 Nov;31(11):1792-1799. | CrossRef | PubMed |
  3. Arthritis foundation. Artritis psoriásica: sus causas, diagnóstico y tratamientos. [On line]. | Link |
  4. Okuno H, Ogura K, Okuyama R, Itoi E. Two cases of acrodermatitis continua of Hallopeau associated with generalized arthritis. Acta Dermatovenerol Croat. 2013;21(4):265-7. | PubMed |
  5. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73. | CrossRef | PubMed |
  6. Dressler C, Eisert L, Pham PA, Nast A. Efficacy and safety of systemic treatments in psoriatic arthritis: a systematic review, meta-analysis and GRADE evaluation. J Eur Acad Dermatol Venereol. 2019 Jul;33(7):1249-1260. | CrossRef | PubMed |
  7. Hallopeau MH. Sur une asphyxie locale des extremities avec polydactylite suppurative chronique et pousseès ephemeres de dermatite pustuleuse disseminée et symetrique. Bull Soc Fr Dermatol Syphiligr. 1890; 1: 39-45.
  8. Twelves S, Mostafa A, Dand N, Burri E, Farkas K, Wilson R, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2019 Mar;143(3):1021-1026. | CrossRef | PubMed |
  9. Barber HW. Acrodermatitis continua vel perstans (dermatitis repens) and psoriasis pustulosa. Br J Dermatol. 1930;42(11): 500-518. | CrossRef |
  10. Diani M, Cozzi C, Altomare G. Heinrich Koebner and His Phenomenon. JAMA Dermatol. 2016 Aug 1;152(8):919. | CrossRef | PubMed |
  11. Alorainy M, Alshaya M, Al-Rikabi A, Ayesh M, Alsaif F. Acrodermatitis Continua of Hallopeau with Bone Resorption in an 8-Year-Old Patient: A Case Report. Case Rep Dermatol. 2017 Dec 18;9(3):259-264. | CrossRef | PubMed |
  12. Gossec L, Smolen JS, Ramiro S, de Wit M, Cutolo M, Dougados M, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016 Mar;75(3):499-510. | CrossRef | PubMed |
  13. Schoels MM, Aletaha D, Alasti F, Smolen JS. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis. 2016 May;75(5):811-8. | CrossRef | PubMed |
  14. Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011 Jan;70(1):47-53. | CrossRef | PubMed |
  15. Lefkir S, Slimani S, Brahimi N, Ladjouze-Rezig A. Successful treatment of Acrodermatitis continua of Hallopeau associated with psoriatic arthritis with adalimumab. Eur J Rheumatol. 2015 Jun;2(2):78-79. | CrossRef | PubMed |
  16. Muggli D, Maul JT, Anzengruber F, Fopp MW, Navarini AA. Secukinumab for Acrodermatitis Continua of Hallopeau. JAMA Dermatol. 2017 Apr 1;153(4):336-337. | CrossRef | PubMed |
  17. Khosravi-Hafshejani T, Zhou Y, Dutz JP. Acrodermatitis Continua of Hallopeau with Psoriatic Arthritis. J Rheumatol. 2019 Apr;46(4):437-438. | CrossRef | PubMed |
  18. Lanna C, Cesaroni GM, Mazzilli S, Lozzi F, Palumbo V, Diluvio L, et al. Nails as immune-privileged sites: A case of disabling Acrodermatitis continua of Hallopeau successfully treated with Apremilast. Dermatol Ther. 2019 Jul;32(4):e12946. | CrossRef | PubMed |
  19. Adas A, Dadban A, Arnault JP, Chaby G, Lok C. Acrodermatitis continua of Hallopeau response to optimized biological therapy. Dermatol Online J. 2019 Feb 15;25(2):13030/qt93s9w1p3. | PubMed |
Sehgal VN, Verma P, Sharma S, Srivastava G, Aggarwal AK, Rasool F, et al. Acrodermatitis continua of Hallopeau: evolution of treatment options. Int J Dermatol. 2011 Oct;50(10):1195-211. | CrossRef | PubMed |

Navarini AA, Burden AD, Capon F, Mrowietz U, Puig L, Köks S, et al. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017 Nov;31(11):1792-1799. | CrossRef | PubMed |

Arthritis foundation. Artritis psoriásica: sus causas, diagnóstico y tratamientos. [On line]. | Link |

Okuno H, Ogura K, Okuyama R, Itoi E. Two cases of acrodermatitis continua of Hallopeau associated with generalized arthritis. Acta Dermatovenerol Croat. 2013;21(4):265-7. | PubMed |

Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73. | CrossRef | PubMed |

Dressler C, Eisert L, Pham PA, Nast A. Efficacy and safety of systemic treatments in psoriatic arthritis: a systematic review, meta-analysis and GRADE evaluation. J Eur Acad Dermatol Venereol. 2019 Jul;33(7):1249-1260. | CrossRef | PubMed |

Hallopeau MH. Sur une asphyxie locale des extremities avec polydactylite suppurative chronique et pousseès ephemeres de dermatite pustuleuse disseminée et symetrique. Bull Soc Fr Dermatol Syphiligr. 1890; 1: 39-45.

Twelves S, Mostafa A, Dand N, Burri E, Farkas K, Wilson R, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2019 Mar;143(3):1021-1026. | CrossRef | PubMed |

Barber HW. Acrodermatitis continua vel perstans (dermatitis repens) and psoriasis pustulosa. Br J Dermatol. 1930;42(11): 500-518. | CrossRef |

Diani M, Cozzi C, Altomare G. Heinrich Koebner and His Phenomenon. JAMA Dermatol. 2016 Aug 1;152(8):919. | CrossRef | PubMed |

Alorainy M, Alshaya M, Al-Rikabi A, Ayesh M, Alsaif F. Acrodermatitis Continua of Hallopeau with Bone Resorption in an 8-Year-Old Patient: A Case Report. Case Rep Dermatol. 2017 Dec 18;9(3):259-264. | CrossRef | PubMed |

Gossec L, Smolen JS, Ramiro S, de Wit M, Cutolo M, Dougados M, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016 Mar;75(3):499-510. | CrossRef | PubMed |

Schoels MM, Aletaha D, Alasti F, Smolen JS. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis. 2016 May;75(5):811-8. | CrossRef | PubMed |

Machado P, Landewé R, Lie E, Kvien TK, Braun J, Baker D, et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011 Jan;70(1):47-53. | CrossRef | PubMed |

Lefkir S, Slimani S, Brahimi N, Ladjouze-Rezig A. Successful treatment of Acrodermatitis continua of Hallopeau associated with psoriatic arthritis with adalimumab. Eur J Rheumatol. 2015 Jun;2(2):78-79. | CrossRef | PubMed |

Muggli D, Maul JT, Anzengruber F, Fopp MW, Navarini AA. Secukinumab for Acrodermatitis Continua of Hallopeau. JAMA Dermatol. 2017 Apr 1;153(4):336-337. | CrossRef | PubMed |

Khosravi-Hafshejani T, Zhou Y, Dutz JP. Acrodermatitis Continua of Hallopeau with Psoriatic Arthritis. J Rheumatol. 2019 Apr;46(4):437-438. | CrossRef | PubMed |

Lanna C, Cesaroni GM, Mazzilli S, Lozzi F, Palumbo V, Diluvio L, et al. Nails as immune-privileged sites: A case of disabling Acrodermatitis continua of Hallopeau successfully treated with Apremilast. Dermatol Ther. 2019 Jul;32(4):e12946. | CrossRef | PubMed |

Adas A, Dadban A, Arnault JP, Chaby G, Lok C. Acrodermatitis continua of Hallopeau response to optimized biological therapy. Dermatol Online J. 2019 Feb 15;25(2):13030/qt93s9w1p3. | PubMed |