Acrodermatitis continua of Hallopeau (ACH), a rare pustular eruption affecting the distal digits, was successfully treated with ustekinumab as monotherapy.
A woman in her 20s presented with recalcitrant and well-demarcated hand dermatitis unresponsive to topical medications including corticosteroids. Her medical history was remarkable for “eczema” dating back to childhood. Patch testing results were negative.
On examination, the left and right third fingers had sharply demarcated erythematous scaly plaques with fissures, scale crust, and nail pitting. The left third finger was confluently covered, leaving the rest of the hand unaffected (Figure 1). This constellation of findings limited to the fingers suggested an eruption consistent with ACH. Given her condition’s recalcitrant history and the typical resistance of ACH to topical medicaments, she was started on a regimen of cyclosporine, 100 mg, twice daily (3.2 mg/kg), tacrolimus ointment nightly, calcipotriene cream daily, and diluted bleach soaks daily. She experienced intolerable gastrointestinal upset, so her cyclosporine dose was decreased to 50 mg twice daily, and the topical applications were increased to twice daily.
Cymerman RM, Cohen DE. Treatment of Acrodermatitis Continua of Hallopeau With Ustekinumab as Monotherapy. JAMA Dermatol. 2016;152(3):346-348. doi:10.1001/jamadermatol.2015.3444