Acrodermatitis continua of Hallopeau (ACH) is a chronic, rare pustular form of psoriasis that affects the distal extremities, particularly the fingers and toes. Although pustules are characteristic, they may not always be clinically apparent, especially in the earlier stages. This condition is often resistant to treatment; therefore, early and accurate diagnosis is essential for proper management and preventing complications.

A 34-year-old male farmer presented with a one-year history of pruritic erythematous scaly plaques involving both palms, thumbs and thumbnails. Pertinent history showed that the lesions appeared after contact with rubber gloves and fertilizers. Irritant versus allergic contact dermatitis were considered, but a negative patch test result ruled out the allergic component. He was treated with topical corticosteroids and was advised to wear cotton gloves under rubber gloves while working which provided relief. However, the plaques recurred now with appearance of pustules on both hands. A skin punch biopsy was done revealing psoriasiform dermatitis with subcorneal pustules, consistent with ACH. The patient was started on methotrexate 7.5 mg/week and topical clobetasol, alternating with calcipotriol with improvement of the palmar plaques and pustules.

ACH is often misdiagnosed due to its pus-filled lesions which may mimic infection or secondarily infected contact dermatitis or dyshidrotic eczema. In this case, the initial presentation mimicked a contact dermatitis, and it was only after patch testing and skin biopsy, that a definitive diagnosis was made.

Human ; Male ; Adult: 25-44 Yrs Old ; Acrodermatitis ; Dermatitis, Contact ; Psoriasis

No abstract available.
Acrodermatitis* ; Adult* ; Humans ; Pityriasis Rubra Pilaris* ; Pityriasis* ; Zinc*

Acrodematitis enteropathica is an uncommon disease due to zinc deficiency which is characterized by perioral and acral dermatitis, alopecia, and diarrhea. This disease typically presents in infants, either due to an autosomal recessive genetic disorder or after cessation of breastfeeding. Acquired adult-onset acrodermatitis enteropathica has rarely been reported so far. We report a case of a 38-year-old man who had a history of chronic alcohol intake and presented with severe acrodermatitis enteropathica. The patient was successfully managed with zinc supplement and supportive care.
Acrodermatitis* ; Adult ; Alopecia ; Breast Feeding ; Dermatitis ; Diarrhea ; Humans ; Infant ; Zinc*

OBJECTIVETo detect pathogenic mutation of the SLC39A4 gene in a male patient with acrodermatitis enteropathica (AE).

METHODSPeripheral venous blood sample and clinical data from the patient and his parents were collected. One hundred unrelated healthy individuals were recruited as controls. All coding exons and flanking exon-intron sequences of the SLC39A4 gene were analyzed by PCR and direct sequencing.

RESULTSThe results revealed that the patient and his mother have both carried a novel frame-shift mutation c.1110InsG (p.Gly370GlyfsX47 to TGA) in exon 6. A novel nonsense mutation c.958C to T (p.Q320X) in exon 5 was also detected in the patient and his father and grandmother. This novel mutation was not detected in the unaffected family members and 100 unrelated healthy controls.

CONCLUSIONThe novel frame-shift mutation c.1110InsG (p.Gly370GlyfsX47 to TGA) derived from the mother and nonsense mutation c.958C to T (p.Q320X) of the SLC39A4 gene derived from the father may underlie the disease in the patient.

Acrodermatitis ; genetics ; Adolescent ; Base Sequence ; Cation Transport Proteins ; genetics ; Exons ; Homozygote ; Humans ; Male ; Molecular Sequence Data ; Mutation ; Pedigree ; Zinc ; deficiency

No abstract available.
Acrodermatitis* ; Atrophy* ; Osteolysis* ; Psoriasis*

Acrodermatitis continua of Hallopeau (ACH) is a rare form of acropustular eruption characterized by a presence of aseptic pustules on inflammatory periungual or subungual regions. Frequently accompanied by paronychia, atrophic skin changes, onychodystrophy, and osteolysis of distal phalanges of the digits, it is considered to be a variant of pustular psoriasis with a chronic relapsing course and refractoriness to many therapeutic modalities. Here, we present a case of a 45-year-old female who presented with multiple pustules pathologically diagnosed as pustular psoriasis on her left thumb. She suffered from ACH for over a decade, and in the process experienced frequent relapses and showed poor response to numerous treatment modalities such as narrow band UVB, topical steroid, steroid intralesional injection, oral retinoids, 308 nm excimer laser, and oral immune suppressants. However, the patient showed dramatic clinical improvements to administration of etanercept (TNF-alpha antagonist, twice a week) for a period of one month. The cessation of etanercept led to recurrence of symptoms and marked deterioration of the skin lesion within a month again, but the re-initiation of treatment soon relieved the problem. After completion of a three months trial of etanercept, the cutaneous lesion subsided, and the patient is now successfully controlled with topical steroid maintenance therapy. Hereby, we report a patient with ACH successfully treated with etanercept.
Acrodermatitis ; Female ; Humans ; Immunoglobulin G ; Injections, Intralesional ; Lasers, Excimer ; Middle Aged ; Osteolysis ; Paronychia ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Recurrence ; Retinoids ; Skin ; Thumb ; Etanercept

Zinc deficiency can result from acrodermatitis enteropathica, an inadequate dietary intake, malabsorption, increased body loss, or intravenous feeding. Unlike acrodermatitis enteropathica, breast feeding-induced acrodermatitis is transient and improves when nursing ends. Breast feeding-induced acrodermatitis is caused by a ZnT-2 transporter dysfunction in the mother's mammary glands. We report a case of a 6-month-old male infant who presented with erythematous patches and plaques involving the perioral, perineal, and acral areas and loose stools since 2 weeks after birth. Atopic dermatitis was considered initially, but the lesions did not respond to topical antibiotics, corticosteroids, or maternal dietary restriction from allergenic food. The patient's serum zinc concentration was low, and the mother's serum and milk had low zinc levels. The differential diagnosis for atopic dermatitis is extensive. Physicians should be alert for the possibility of zinc deficiency dermatitis in breast milk fed infants that mimics atopic dermatitis.
Acrodermatitis ; Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Breast ; Dermatitis ; Dermatitis, Atopic ; Diagnosis, Differential ; Humans ; Infant ; Male ; Mammary Glands, Human ; Milk ; Milk, Human ; Parenteral Nutrition ; Parturition ; Zinc

Gianotti-Crosti syndrome (GCS) is a sporadic dermatosis affecting mainly children. It is characterized by multiple, confluent, monomorphic and pruritic pink to red-brown papules or papulovesicles, distributed symmetrically on the face, extensor surfaces of the extremities and buttocks, commonly sparing the trunk, palms and soles. This can be preceded by a viral infection, and may be accompanied by fever, hepatosplenomegaly, or lymphadenopathy. Personal and family history of atopy appears to be a risk factor in the subsequent development of GCS, thus frequently diagnosed as atopic dermatitis. We report a case of a 4-year-old boy from our institution with generalized, pruritic, papulovesicular rashes on the face and extremities for one month. He was diagnosed to have atopic dermatitis and treated as such, before presentation to our institution. As the signs and symptoms in GCS are similar to atopic dermatitis, we suggest that this diagnosis be considered when presented with a similar case.
Acrodermatitis ; Buttocks ; Child ; Child, Preschool ; Dermatitis, Atopic ; Diagnosis ; Exanthema ; Extremities ; Fever ; Humans ; Hypersensitivity ; Lymphatic Diseases ; Male ; Risk Factors ; Skin Diseases

Acrodermatitis enteropathica (AE) is an uncommon autosomal recessive genetic disorder of zinc malabsorption. The acquired form may be associated with inadequate intake, impaired absorption, and increased excretion of zinc. Those afflicted present with diarrhea, stomatitis, psychiatric symptoms, non-scarring alopecia, and nail dystrophy accompanied by erythematous which appears as scaly patches with erosion vesicles and pustules mostly affecting the extremities, perineal, and periorificial areas. Due to the variable findings of most case reports, the clinical and histopathological features of AE are often regarded as non-specific. We report an unusual case of bullous AE secondary to total parenteral nutrition for the treatment of acute pancreatitis occurring in a six-year-old male with acute lymphocytic leukemia who underwent chemotherapy. He presented with periorificial, reddish, eroded bullae with multiple vesicles and blisters on his fingers, toes, and buttock, showing necrotic keratinocytes with multiple intraepidermal vesicles and perivascular infiltration with predominant lymphocytes and few neutrophils within the dermis. To the best of our knowledge, this is the first case report of bullous AE in the Korean dermatologic literature.
Absorption ; Acrodermatitis ; Alopecia ; Blister ; Buttocks ; Cytochrome P-450 CYP1A1 ; Dermis ; Diarrhea ; Extremities ; Fingers ; Humans ; Keratinocytes ; Lymphocytes ; Male ; Nails ; Neutrophils ; Pancreatitis ; Parenteral Nutrition, Total ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Stomatitis ; Toes ; Zinc

Acrodermatitis enteropathica is classified as a congenital autosomal recessive type and an acquired transient type. This disease manifests as acral and periorificial dermatitis, alopecia, intractable diarrhea, and failure to thrive. Whereas the autosomal hereditary type is caused by malabsorption of zinc in the intestine, the acquired type is caused by low nutritional support or decreased peripheral release of zinc from blood. We experienced a case of a 5-month old, breast feeding, full-term female presenting with only acral bullous dermatitis without diarrhea, periorificial dermatitis and an abnormal serum zinc level.
Acrodermatitis ; Alopecia ; Breast Feeding ; Dermatitis ; Diarrhea ; Failure to Thrive ; Female ; Foot ; Hand ; Humans ; Intestines ; Nutritional Support ; Zinc