Acrodermatitis Continua of Hallopeau (ACH) or Palmoplantar Pustular Psoriasis (PPP) 连续性肢端皮炎还是掌跖脓疱型银屑病

A 30-year-old female presented fingers and toe nails onychodystrophy with concurrent pain. Patient reported that the first lesion started on her right index finger nail 12 months ago. It gradually involved her other finger and toe nails. On examination, the skin over the distal phalanx becomes pinkish and scaly and no pustules observed. The nail plate is partially destroyed. She applied antifungal cream (Miconazole) and took multivitmines and glucosamine for her nail onychodystrophy. She has no family history of psoriasis and personal medical history.

The patient was instructed to take the TANGS herbal medicine twice daily. At a 8-month follow-up visit, her finger pain and nail changes had abated. She continued with the same herbal therapy and her onychodystrophy was resolved after 3 years.

Acrodermatitis3

Discussion

ACH has also been called pustular acrodermatitis, acrodermatitis continua suppurativa, dermatitis perstans, acropustulosis, acrodermatitis perstans, and dermatitis repens [1-4].

As far as classified, whether acrodermatitis continua of Hallopeau ACH is considered a localized form of pustular psoriasis or independent entity has been debated since the symptom was first recognized by Hallopeau in 1890 [5-7]. Patients with acrodermatitis continua of Hallopeau do not usually have additional plaque psoriasis. The distribution of lesions in acrodermatitis continua of Hallopeau is distinctive, as are the local destruction of soft tissue, nail apparatus and sometimes the terminal digit.

ACH is a rare entity, described in case reports and small case series only. Its incidence and prevalence are unknown. Clinical features may overlap with palmoplantar pustulosis psoraisis PPP and may evolve into generalized pustular psoriasis [8,9]. The eruption typically occurs after local trauma or infection, but such a history is not always present and various other etiologies have been described including infectious, neural, inflammatory, and genetic causes. The features are similar to those of generalized pustular psoriasis. In the epidermis, there are numerous subcorneal neutrophilic pustules and spongiform pustules with hypergranulosis and parakeratotic hyperkeratosis. There is a lymphocytic infiltration in the dermis, from which chronic disease may become atrophic.

一位30岁女性患者出现了手指和脚趾甲变形，并伴有疼痛。患者报告12个月前最初的病变出现在她的右手食指指甲，随后逐渐发展到了其他手指甲和脚趾甲。检查时，患者双手远端指骨上的皮肤变成了粉红色和有少许鳞状皮肤，并没有观察到脓疱。指甲板部分被破坏。她曾经使用抗真菌（咪康唑）药膏并服用维生素和葡萄糖胺治疗其甲变形。她没有牛皮癣的家族史和个人病史。

建议患者每日服用唐氏中医TANGS CLINIC中药两次。在8个月的随访访视中，她的手指疼痛和指甲变化已经减轻。她继续服用中药治疗，3年后甲变形恢复正常。

ACH连续性肢端皮炎还被称为脓疱性远端肢体皮炎、持续化化脓性远端肢体皮炎、持续性皮肤炎、远端肢体脓疱病、持续性远端肢体皮炎和远端肢体皮肤持续性扩散性皮炎 [1-4]。

关于分类，自从Hallopeau于1890年首次发现该症状以来，ACH持续性远端肢体皮炎被认为是局限性脓疱型银屑病还是独立的实体一直存在争议 [5-7]。持续性远端肢体皮炎患者通常不会同时患有银屑病。ACH病变的分布是独特的，软组织、指甲和手指脚趾末梢的局部破坏也是独特的。

ACH是一种罕见的疾病，仅有病例报告和少数病例系列报道。其发病率和患病率未知。临床特征可能与掌跖型脓疱症银屑病PPP重叠，并可能发展为广泛性脓疱型银屑病 [8,9]。这种皮疹通常发生在局部创伤或感染后，但并不总是有这样的病史，文献也曾描述各种其他病因，包括感染、神经、炎症和遗传原因。在表皮组织病理切片中，有许多亚角质性中性粒细胞脓疱和海绵状脓疱，伴有过度颗粒层和表皮角质过度增生。在真皮中有淋巴细胞浸润，慢性病变时可能出现真皮萎缩。

 

Reference

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