Acrodermatitis persistent pustular allopo: causes, symptoms, diagnosis, treatment

Acrodermatitis persistent pustular Hallopeau (synonyms: acropustulosis, Crocker's persistent dermatitis) is a chronic relapsing disease characterized by lesions of the coccyx of the fingers and toes, on which there are pustular rashes that tend to spread.

The causes and pathogenesis of persistent pustular acrodermatitis of Hallopeau have not been established. Some scientists believe that the disease is based on an infectious agent. However, the contents of phlyctenae and pustules and the patient's blood are often hereditary. Other scientists consider generalized pustular psoriasis of Zumbusch, persistent dermatitis of Hallopeau and herpetiform impetigo of Hebra as one disease. The author's clinical observations allow us to consider persistent acrodermatitis as an independent dermatosis.

Symptoms of Persistent Pustular Acrodermatitis of Hallopeau

The onset of the disease is usually associated with minor trauma or pyoderma. The rash is localized on the palps (hands and feet), especially in the area of the distal phalanges around the nail plates, in the form of pustular, vesicular or erythematosquamous elements. At the beginning, the process is localized, asymmetrical and unilateral, most often one finger, mainly the thumb, is affected, then other fingers are involved in the process, less often - toes. Clinically, pustular, vesicular and erythematosquamous forms of the disease are distinguished. Over time, the lesions can spread to adjacent areas of the hands and feet, rarely - to the entire skin. In some patients, secondary atrophic changes in the skin are observed.

In pustular and vesicular forms, the nail folds are edematous, red (hyperemic), and infiltrated. When pressing on the nail plates, pus is released. Multiple pustules and vesicles appear on the affected phalanx, which open up, forming erosions, then become covered with crusts and scales. The fingers become cylindrical, bending and unbending them is difficult due to pain. After the inflammatory process subsides, slight atrophy and tender reddish skin remain at the site of the rash.

In the visual-squamous form, the affected fingers are red, dry, flaky and have superficial cracks. In mild cases of dermatosis, the nail plates have grooves and punctures on their surface, and in the pustular form, onycholysis is observed or the nail plates fall off.

The disease can sometimes proceed malignantly. In this case, the process spreads to the entire skin, nails fall out, and fingers become mutilated.

Histopathology of acrodermatitis persistente pustularis of Hallopeau. Histological examination is characterized by the presence of spongiosiform pustules of Kagoya, as in pustular psoriasis of Zumbusch and impetigo herpetiformis.

Pathomorphology of persistent pustular acrodermatitis of Hallopeau. Acanthosis with elongation and expansion of epidermal outgrowths, hyperkeratosis, parakeratosis, and later thinning of the epidermis are expressed. A characteristic histological feature of this disease is the presence of spongiform pustules of Kogoy. Large pustules are sometimes located one under another, their cover is formed by a thinned horny layer, at the base there are small spongiform pustules. Pustules contain neutrophilic granulocytes, single epithelial cells. In the dermis, edema, vasodilation and a significantly burned inflammatory infiltrate of neutrophilic granulonites, lymphocytes, histiocytes and a small number of plasma cells are noted.

Histogenesis is poorly understood. It is unclear whether persistent suppurative acrodermatitis of Hallopeau is a localized variant of pustular psoriasis or an independent dermatosis.

Differential diagnosis. The disease must be differentiated from pustular psoriasis, eczema, pyoderma, Andrews' pustular bacteride, and Duhring's herpetiform dermatitis.

Treatment of persistent pustular acrodermatitis Hallopeau

Treatment depends on the clinical course and intensity of skin changes. For systemic therapy, etretinate, corticosteroids, PUVA therapy, cyclosporine or methotrexate are used. For local treatment, Castellani paint, calcipatriol, ointments containing corticosteroids and antibiotics are recommended.

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