Case report : Use of Phototherapy for Acrodermatitis Continua of Hallopeau in Childhood: Case Report and Review of the Literature

Abstract

A 6-year-old girl presented to our attention with a 7-month history of erythema and pustules on the distal portion of her left first finger, which deeply affected the beginning of her scholar activity. On examination, her digit was swollen, markedly erythematous, and littered with several small pustules; nail was strikingly dysmorphic. The other digits showed variable degree of onychodystrophy (Fig. 1A). There were neither prior history of psoriatic lesions nor familiarity for psoriasis. Microscopic and cultural examination did not show any microbiological infection. Histological sample showed psoriasiform hyperplasia, with a collection of granulocytes in the context of parakeratosis as well as in the intraepithelial area (Munro-like microabscesses), and focal spongiosis with absent granular layer. The dermis showed increased vascularity within the dermal papillae. Ultrasonography highlighted cutaneous and sub-cutaneous thickness increase with intra-articular synovial effusion (Fig. 1C); at color Doppler, increase of vascularization was present in sub-cutaneous tissue (Fig. 1D). On the basis of these findings, a diagnosis of acrodermatitis continua of Hallopeau (ACH) was performed. Past treatment only consisted of topical steroids. A cycle of clobetasol 0.05% ointment under occlusion and narrow band UVB (310 -311 nm) was prescribed for 30 days. The improvement observed at follow-up visit (Fig. 1B), increased after the subsequent 2 months of therapy, without relapse. The young patient is still under treatment and no relapse was notead at 3.5 months follow-up.