Acrodermatitis of Hallopeau and erosive oral mucositis successfully treated with secukinumab

ACH: acrodermatitis continua of Hallopeau IL-17: interleukin 17 INTRODUCTION ‘‘Treatment of acrodermatitis continua of Hallopeau is difficult and often disappointing.’’ ‘‘Oral lesions of psoriasis are rare clinical observations.’’ Acrodermatitis continua of Hallopeau (ACH) is characterized by chronic, painful, destructive, and typically disabling disease of the hands and feet. It is considered an uncommon variant of pustular psoriasis that does not readily respond to standard topical or systemic treatments for psoriasis. ACH was first described as a suppurative process that affects the fingertips and hands in 1890 by Hallopeau. If left untreated, the disease process can result in sclerosis and osteolysis, as well as onychodystrophy and anonychia. Numerous topical and systemic treatments have been utilized in the treatment of ACH including phototherapy, topical and systemic vitamin A derivatives, topical vitamin D derivatives, and immunosuppressant therapy. Possibly due to underreporting, it is not evident in the literature whether oral lesions of psoriasis are associated with ACH. The true incidence of intraoral psoriasis is lacking from the medical literature, mostly because of the inconsistency of histologic patterns and clinical presentation of disease, which ranges from geographic tongue to erosive glossitis, includes painful and nonpainful lesions, and might or might not include cutaneous involvement. Oral lesions might wax and wane, making diagnosis even more difficult to confirm.