What are the other Names for this Condition? (Also known as/Synonyms)

• ACH (Acrodermatitis Continua of Hallopeau)
• Acropustulosis of Hallopeau
• Dermatitis Repens

What is Acrodermatitis Continua of Hallopeau? (Definition/Background Information)

• Acrodermatitis Continua of Hallopeau (ACH) is an inflammatory skin condition of unknown cause that is generally observed in women. This rare and chronic condition is characterized by multiple pus-filled lesions on the tips of fingers and toes. The lesions are usually present around and under the nail plate
• Acrodermatitis Continua of Hallopeau is a progressive condition with no effective treatment measures currently available. The condition can begin with a digit and involve all the fingers and toes and move to affect the hands and feet. The prognosis depends on the severity of the signs and symptoms

Who gets Acrodermatitis Continua of Hallopeau? (Age and Sex Distribution)

• Acrodermatitis Continua of Hallopeau are generally observed in adults. It is not very common in children
• Both males and females are affected, although a greater number of cases are observed in women
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Acrodermatitis Continua of Hallopeau? (Predisposing Factors)

• The risk factors for Acrodermatitis Continua of Hallopeau are currently unidentified

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acrodermatitis Continua of Hallopeau? (Etiology)

The exact cause of formation of Acrodermatitis Continua of Hallopeau (ACH) is presently not well-understood.

• It is categorized as an autoimmune disorder that may be triggered by an infection or local trauma
• Some experts believe that ACH is a variant of pustular psoriasis

What are the Signs and Symptoms of Acrodermatitis Continua of Hallopeau?

The signs and symptoms of Acrodermatitis Continua of Hallopeau may include:

• Onset of the condition is usually from the tip of a finger, usually the thumb. In about 80% of the cases, the initial onset starts with a finger or toe
• The condition is acute and progressive in nature
• Small pus-filled blisters (pustules) form on the digits, usually around or under the nail plate, following an acute flare-up that is characterized by redness and scaly formation
• The small pustules usually coalesce to form large ulcerous lesions that painfully rupture and discharge pus
• Following this, the skin peels off to reveal raw, red, and shiny skin below from which new blisters develop
• The nails of the fingers and toes may be involved causing malformation and loss of nail
• All the fingers and toes may develop the condition, which then spreads to the hands, wrists, and forearms. Similarly, following involvement of the toes, the feet are affected

Severe pain, burning sensation, and discomfort may be observed.

How is Acrodermatitis Continua of Hallopeau Diagnosed?

A diagnosis of Acrodermatitis Continua of Hallopeau may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests, analysis of pus, and culture of the fluid being drained, as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Potassium hydroxide (KOH) preparation: Microscopic observation of a sample to exclude fungal and yeast infections
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• X-Rays to determine if bone is involved

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acrodermatitis Continua of Hallopeau?

The possible complications due to Acrodermatitis Continua of Hallopeau (ACH) include:

• Severe emotional stress due to cosmetic issues
• Superimposed bacterial and fungal skin infections
• ACH may involve the finger or hand bones causing their destruction (osteolysis)
• It may also involve the mucosal membranes of the eye, tongue, and urethra
• Difficulty in performing simple daily tasks
• Difficulty in walking
• Loss of finger, toe, or limb
• ACH is a chronic condition with a recurrent-relapsing course
• In adults, this progressive condition may result in generalized pustular psoriasis with severe skin symptoms
• Treatment complications

How is Acrodermatitis Continua of Hallopeau Treated?

Presently, there are no well-defined treatments available for Acrodermatitis Continua of Hallopeau. The condition is also difficult to manage since it also recurs chronically. However, the healthcare provider may consider the following measures:

• Application of topical agents that include 5-fluorouracil, tacrolimus, and calcipotriol
• Intralesional corticosteroids
• Administration of medications including methotrexate, cyclosporin, acitretin, and prednisone
• Phototherapy (PUVA or narrowband UVB)
• TNF inhibitor medications and monoclonal antibodies such as anti-IL 17
• Radiation therapy, namely high-dose brachytherapy
• Rehabilitation therapy for severe cases

Regular follow up visits with the healthcare provider is important and recommended.

How can Acrodermatitis Continua of Hallopeau be Prevented?

Presently, there are no guidelines available to prevent Acrodermatitis Continua of Hallopeau.

What is the Prognosis of Acrodermatitis Continua of Hallopeau? (Outcomes/Resolutions)

The prognosis of Acrodermatitis Continua of Hallopeau (ACH) depends on its severity. The currently available treatments are also not known to be very effective in addressing the symptoms.

• In a majority of cases, the condition is relentlessly progressive and recurrent; a long-term morbidity is often associated with ACH
• Regular and aggressive management of severe cases may help achieve a certain measure of control

Additional and Relevant Useful Information for Acrodermatitis Continua of Hallopeau:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/