INTRODUCTION
Acrodermatitis continua of Hallopeau (ACH) is a rare, localized variant of pustular psoriasis. Fewer than 200 cases have been reported in the literature. It is characterized by recurrent, tender, sterile pustules with underlying erythema affecting the distal digits, typically with consistent involvement of the nail apparatus.1 Complications can include onychodystrophy leading to anonychia, as well as osteolysis of the distal phalanges.1 The condition follows a chronic, relapsing course and is often recalcitrant to conventional therapy. Management is particularly challenging due to the lack of standardized treatment guidelines, largely stemming from the rarity of ACH. While several case reports have demonstrated success with therapies commonly used in plaque psoriasis,1 an increasing number of cases have reported promising responses to bimekizumab.2-4 Here, we present a case of a 67-year-old male with ACH who responded to bimekizumab after failing treatment with deucravacitinib. This case adds to the growing body of evidence supporting bimekizumab,a dual IL-17A and IL-17F inhibitor, as a therapeutic option for ACH.
CASE PRESENTATION
A 67-year-old male presented in 2024 with a several-month history of pain, inflammation, and a rash involving the distal digits of both hands and his left foot. He reported progressive difficulty performing manual work as a motorcycle mechanic due to swelling and joint discomfort localized to the fingertips. Initial treatment with doxycycline, mupirocin, and oral terbinafine was ineffective.
His past medical history was significant for type 2 diabetes mellitus and hypertension. Current medications included dapagliflozin, pantoprazole, lisinopril, and extended-release saxagliptin/metformin.
On physical examination, several fingers and the lateral toes of the left foot exhibited erythematous, scaling plaques with nail dystrophy and subungual pustules. Nail involvement was prominent, with multiple fingernails and the lateral two toenails of the left foot affected.
A shave biopsy of an active lesion on his left index finger was performed, and laboratory testing, including a comprehensive
His past medical history was significant for type 2 diabetes mellitus and hypertension. Current medications included dapagliflozin, pantoprazole, lisinopril, and extended-release saxagliptin/metformin.
On physical examination, several fingers and the lateral toes of the left foot exhibited erythematous, scaling plaques with nail dystrophy and subungual pustules. Nail involvement was prominent, with multiple fingernails and the lateral two toenails of the left foot affected.
A shave biopsy of an active lesion on his left index finger was performed, and laboratory testing, including a comprehensive
