Treatment of acrodermatitis continua of Hallopeau: A case series of 39 patients
Autor: | Rotraut Mössner, Marthe-Lisa Schaarschmidt, Andreas Pinter, Daniel Celis, Sietske Poortinga, Sascha Gerdes, Dagmar Wilsmann-Theis, Emilia Loewe, Christian Kromer |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty Dermatology Acitretin 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Psoriasis Internal medicine medicine Adalimumab Humans Prospective Studies Retrospective Studies business.industry Acrodermatitis Retrospective cohort study General Medicine Middle Aged medicine.disease 3. Good health Guselkumab 030220 oncology & carcinogenesis Methotrexate Secukinumab Female Dermatologic Agents business medicine.drug |
Zdroj: | The Journal of dermatologyReferences. 47(9) |
ISSN: | 1346-8138 |
Popis: | Acrodermatitis continua of Hallopeau (ACH) is a rare chronic inflammatory skin disease. Treatment is extremely challenging and mostly based on empirics as there is only scarce evidence from case reports and few small case series. In this retrospective study, patients with ACH treated at five university medical centers were analyzed according to patient and disease characteristics and treatment experience. We identified 39 patients with ACH with a mean age of 54.4 years at onset, of whom 22 (56.4%) were female. A total of 115 systemic treatment courses were analyzed with methotrexate as the most common therapy (27.0%). Overall, effectiveness of systemic treatments was low (excellent response rate: 14.8%). Among non-biologics, excellent response was noted in 21.1% (4/19) of treatment courses with methotrexate, followed by acitretin (13.3%; 2/15). Among biologics, guselkumab (excellent response: 100%; 2/2), secukinumab (excellent response: 42.9%; 3/7) and adalimumab (excellent response: 20.0%; 2/10) were most efficacious. The median drug survival was 7.0 months and did not differ significantly between the subgroup of non-biologic and biologic therapies. To our knowledge, this is the largest case series in ACH investigating patient characteristics and treatment outcomes. Based on our treatment experience, we suggest a treatment algorithm starting with acitretin or methotrexate as first-line therapy, followed by biologics. Cyclosporin may be used for short-term control. However, none of the applied systemic therapies yielded satisfying efficacy in our cohort. In patients with primary non-response, switch of treatment should be evaluated timely on an individual basis, considering possible irreversible disease complications such as nail loss. More research with prospective design is needed to further evaluate traditional and also particularly newer antipsoriatic drugs in ACH. |
Databáze: | OpenAIRE |
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