clobetasol and Acrodermatitis

Acrodermatitis continua of Hallopeau (ACH) is a rare acropustular eruption, characterized by sterile pustules, paronychia and atrophic skin changes, onychodystrophy and osteolysis of the distal phalanges of the fingers and toes. It is considered to be a variant of pustular psoriasis with a chronic relapsing course and frequent refractoriness to many therapeutic modalities, which can be amenable to successful treatment by tumor necrosis factor alpha antagonists. We report 1 patient with pustular psoriasis and ACH whom we have treated successfully with etanercept (for 30 months) and then adalimumab (for 13 months and ongoing). Blanching was initially achieved with etanercept 50 mg twice a week, but suppression of periungual inflammation then required combination therapy with etanercept 50 mg twice a week and methotrexate 10 mg weekly; lower doses of both drugs did not allow complete control of the disease. Eventually, adalimumab 40 mg every 2 weeks has provided the most cost-effective response in this patient, allowing maintenance of response with partial nail regrowth under monotherapy.

Topics: Acitretin; Acrodermatitis; Adalimumab; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Betamethasone; Clobetasol; Cyclosporine; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin G; Methotrexate; Mycophenolic Acid; Nails; Paronychia; Psoriasis; Receptors, Tumor Necrosis Factor; Tumor Necrosis Factor Inhibitors

Two unrelated adult patients are described who both developed an exanthem with the characteristic morphology and distribution of the Gianotti-Crosti syndrome. The literature of adult cases of Gianotti-Crosti syndrome is reviewed with the suggestion that the syndrome may not be as uncommon as previously supposed.

Topics: Acrodermatitis; Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Emollients; Female; Glucocorticoids; Humans; Middle Aged

Topics: Acrodermatitis; Administration, Cutaneous; Aged; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Diagnosis, Differential; Fingers; Hand Dermatoses; Humans; Male; Nails, Malformed

Topics: Acrodermatitis; Clobetasol; Drug Therapy, Combination; Humans; Male; Mechlorethamine; Middle Aged; Neomycin; Nystatin; Staphylococcal Infections