Acrodermatitis Continua
Basics
Basics

Basics
- A variant of pustular psoriasis that has a persistent, relapsing course. Classified as a noninfectious neutrophilic dermatosis; acropustular eruption with a predilection for distal digits characterized by sterile pustules; early nail involvement
- Synonym(s): acrodermatitis continua of Hallopeau; acrodermatitis perstans; dermatitis repens; pustular acrodermatitis
Description
Description
Description
- Acute manifestations
- Formation of multiple, sterile, painful pustules that have an erythematous base located surrounding and under the nail(s) that coalesce to form polycyclic “lakes of pus,” which subsequently rupture and crust
- Chronic sequelae
- Nail changes: paronychia, onychodystrophy, onycholysis, onychomadesis, and anonychia
- Scaling of the nail bed and periungual skin
- Sclerosis or atrophy of soft tissue adjacent and deep to nail bed
- Osteolysis of underlying bone, particularly distal phalanges
- Distribution
- Typically affect distal extremities, affecting 1 to 2 digits, most frequently the 1st digits of the hands; can involve all fingers and toes
- Predilection for dorsal surfaces of hands and feet
- Spare the central palmar/plantar regions
- Rarely spread proximally to involve feet, ankles, hands, and forearms. Isolated proximal psoriatic plaques are rare.
Epidemiology
Epidemiology
Epidemiology
- Exceedingly rare: Only case studies and series are available.
- Female predominance
- Predominantly in adults but also seen in children: observed in 4.7% cases of infantile psoriasis in one series
Etiology and Pathophysiology
Etiology and Pathophysiology
Etiology and Pathophysiology
- Immune dysregulation: Acute-phase reactants such as IL-1 and IL-36 likely play a role in pathogenesis (1).
- In some instances, digital trauma or infection may be an inciting event.
Genetics
- Reported associations with mutations in the IL36RN gene, which codes for the IL-36 receptor antagonist and is a cause of familial generalized pustular psoriasis (1,2)
- No observed relationship with plaque psoriasis–associated alleles HLA-B13, HLA-B17, or HLA-BW37
Risk Factors
Risk Factors
Risk Factors
- History of psoriasis, particularly pustular variant
- Digital trauma
- Local infection
- Smoking may contribute to exacerbations.
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