Acrodermatitis continua of hallopeau: aggravating factors and treatment outcomes of 96 patients.

Background: Acrodermatitis continua of Hallopeau (ACH) is a rare pustular psoriasis variant predominantly affects the distal phalanges of the fingers and toes. However, data on aggravating factors and treatment outcomes is limited.

Objective: This study aims to analyze the aggravating factors and treatment outcomes of ACH in a three-tertiary-hospital in South China.

Methods: We analyzed ACH patients from Dermatology Hospital of Southern Medical University, considering patient and disease characteristics along with treatment experiences.

Results: We identified 96 ACH patients. Various predisposing events were identified, including lifestyle factors, vaccination, stress, trauma, menstruation and drug exposure. A total of 293 systemic treatment courses were analyzed. 54.3% of patients received at least one biologic therapy, while 45.7% were treated with nonbiologic treatments. Acitretin was the most common therapy (20.5%). However, the effectiveness of systemic treatments was low (excellent response rate: 26.3%). Among non-biologic treatments, Acitretin showed a significant response in 30.0% (18/60) of cases, followed by cyclosporin (20.0%, 2/10). Among biologics, spesolimab had the best response rate at 75.0% (n = 3), followed by ixekizumab (44.4%, 8/18). Small molecule drugs did not yeild satisfactory outcomes in ACH treatment.

Conclusion: Identifying triggers and aggravating factors is crucial for effective ACH treatment. We suggest that biologics may be a useful first-line treatment option for clinicians managing ACH.