Uselessness of topical calcipotriol as monotherapy for acrodermatitis continua of Hallopeau.

S ir, that hypergranulosis in the nail matrix probably re ects an in ammatory insult. In our opinion the anatomical and physioIt is well known that the management of Hallopeau acrodermatitis, a rare manifestation of pustular psoriasis, is often disaplogical characteristics of the nail unit probably play a major role in determining the pathological diŒerences between skin pointing and there is still no eŒective therapy or stated guidelines for this pathology. Controversial dermatological and nail, which might explain the unsatisfactory results in the topical treatment with calcipotriol ointment. Furthermore, it studies about the e ciency of topical calcipotriol in the treatment of the disease have been released over the past is known that the disease is characterized by a chronic course with cyclic pustular recurrences at monthly intervals, and that few years. Mozzanica & Cattaneo (1), in describing one case of spontaneous improvement may take place, though rarely. None of the 7 patients aŒected with acrodermatitis continua acrodermatitis continua of Hallopeau responding to topical calcipotriol, observed an improvement after 28 days of therapy of Hallopeau described by us and treated with calcipotriol presented any improvement of the clinical picture. and an almost complete healing after 4 months of treatment. This case is similar to that of Emtestam & Weden (2). On the We believe that singular cases, similar to the one described by Mozzanica & Cattaneo (1), are not su cient to be able to other hand, Kuijpers et al. (3) described one case responding to a combined therapy of calcipotriol and acitretin as well as draw conclusions regarding the e cacy of calcipotriol in the control of acrodermatitis of Hallopeau. a case of Hallopeau acrodermatitis resistant to calcipotriol alone, responding only to a low dose of cyclosporine (4). We previously described three patients suŒering from REFERENCES Hallopeau acrodermatitis who were resistant to calcipotriol monotherapy (5). They were treated with calcipotriol ointment 1. Mozzanica, Cattaneo A. The clinical eŒect of topical calcipotriol (50 l g/g) twice a day; one of them worsened during the in acrodermat itis continua of hallopeau ( letter). Br J Dermatol 1998; 138: 556. treatment and discontinued therapy after 2 weeks, while the 2. Emtestam L, Weden U. Successful treatment for acrodermat itis other two did not present any substantial improvement after continua of Hallopeau using topical calcipotriol. Br J Dermatol 45 days. Recently, we observed three other patients (males 1996; 135: 644–646. of 48, 52 and 58 years old ) who presented severe relapsing 3. Kuijpers AL, van Dooren Greebe RJ, van de Kerkhof PC. acrodermatitis continua of Hallopeau unresponsive to calcipoAcrodermat itis continua of Hallopeau: response to combined treattriol applied twice a day for 3 months (prescribed by other ment with acitretin and calcipotriol ointment. Dermatology 1996; dermatologists). We now describe a seventh patient, a 72-year192: 357–359. old man, who presented with Hallopeau acrodermatitis invol4. Bugatti L, F ilosa G , Nicolini M, Ciattaglia G . Hallopeau’s acroder ving four Ž ngers of his right hand and three of the left, and matitis continua responding to low dose cyclosporin therapy. Chron who was prescribed calcipotriol ointment twice a day. As he Dermatol 1997; 7: 379–383. 5. Plozzer C, Lavaroni G , Torsello P, Kokelj F . Ine cacia del did not observe any improvement, he decided himself to calcipotriolo topico nella terapia dell’acrodermat ite continua di occlude the lesions from the 10th day of treatment. After 51 hallopeau. Chron Dermatol 1997; 7: 349–352 (English abstract: days the clinical picture remained unchanged and the treatment 352). was interrupted. 6. Fanti Pa, Tosti A, Cameli N , Varotti C. Nail matrix hypergranAcrodermatitis continua of Hallopeau is a chronic localized, ulosis. Am J Dermatopathol 1994; 16: 607–610. relapsing, sterile eruption of the extremities, with marked involvement of the nail bed. Histological examination of the nail unit shows hyperplasia and papillomatosis, deŽ nite hyperAccepted February 22, 2001. keratosis with a prominent granular layer (normally absent in the nail matrix), as well as orthoand para hyperkeratosis F. Kokelj, C. Plozzer and G. Trevisan with numerous microabscesses of polymorphonuclear granuloInstitute of Dermatology, University of Trieste, Via Stock, 2, IT-34100 Trieste, Italy. cytes in the parakeratotic horny layer. Fanti et al. (6) underline