clobetasol and Paronychia

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

Topics: Adult; Alopecia Areata; Anti-Inflammatory Agents; Child, Preschool; Clobetasol; Dose-Response Relationship, Drug; Female; Foot Dermatoses; Hand Dermatoses; Humans; Hypopigmentation; Male; Nails, Ingrown; Nails, Malformed; Paronychia; Skin Pigmentation

Topics: Administration, Topical; Adolescent; Age Factors; Child; Clobetasol; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Nail Diseases; Nails; Nails, Ingrown; Nails, Malformed; Ointments; Paronychia; Recurrence; Retrospective Studies; Risk Assessment; Severity of Illness Index; Toes; Treatment Outcome; Young Adult

We report six HIV patients who developed painful periungual inflammation of several nails during treatment with the antiretroviral drugs indinavir and lamivudine. The lesions appeared 2-12 months after starting treatment. The occurrence of paronychia in HIV patients has recently been reported in two groups of patients receiving either indinavir or lamivudine. Dermatologists should be aware of this recently reported and probably not uncommon side-effect of antiretroviral treatment in order to avoid an invasive approach to the nail lesions.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-HIV Agents; Anti-Inflammatory Agents; Clobetasol; Drug Therapy, Combination; Female; Glucocorticoids; HIV Infections; Humans; Indinavir; Lamivudine; Male; Middle Aged; Mupirocin; Paronychia