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The Cutting Edge: Challenges in Medical and Surgical Therapies |

Acitretin- and Tumor Necrosis Factor Inhibitor –Resistant Acrodermatitis Continua of Hallopeau Responsive to the Interleukin 1 Receptor Antagonist Anakinra

Virginie Lutz, MD; Dan Lipsker, MD
Arch Dermatol. 2012;148(3):297-299. doi:10.1001/archdermatol.2011.2473.
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Acrodermatitis continua of Hallopeau is a variant of pustular psoriasis, which can be very difficult to treat. We describe a patient who could not be controlled with most approved drugs for psoriasis including acitretin, methotrexate, tumor necrosis factor (TNF) inhibitors, and ustekinumab. The interleukin 1 (IL-1) receptor antagonist anakinra was rapidly effective and allowed controlling fever and pustulation. Targeting IL-1 could be an important alternative to the classic treatments of pustular psoriasis.

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Figure 1. Erythematosquamous eruption covered by many pustules on the hands.

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Figure 2. An almost complete regression of the pustules at 24 hours after the start of anakinra therapy.

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