Apremilast Coadministered with Secukinumab for Effective Treatment of Acrodermatitis Continua of Hallopeau: A Case Report

Abstract

Background: Acrodermatitis continua of Hallopeau (ACH) is a chronic, relapsing variant of pustular psoriasis proven to be remarkably challenging to treat. There are cases in the literature describing successful treatment with biologic therapy for plaque psoriasis. However, there is less evidence on long-term management of the disease. Evidence from previous case reports suggests that for patients with plaque psoriasis who have failed monotherapy with biologics, the combination of biologics and small molecule drugs can be considered as a treatment option. For patients with ACH, there is currently a gap in research in this area. Further information is needed to help dermatologists formulate treatment plans for patients presenting with such diseases.

Case summary: We report the case of a 44-year-old man with an 8-year history of acrodermatitis continua of ACH. The patient started treatment with secukinumab (300 mg, once every 4 weeks) four years ago. This dramatically improved disease symptoms, with clearance of pustules and absence of pain. Unfortunately, the rash recurred after 2 years of treatment. The patient was transitioned to secukinumab (300 mg, once every 4 weeks) and apremilast (30 mg, twice daily), well-controlled ACH lesions. After 5 months, secukinumab was tapered to 300 mg every 8 weeks. During the 2 years of treatment, laboratory workup was within normal limits.

Conclusion: This case underscores that the combination therapy of secukinumab and apremilast can offer a promising approach for the long-term management of ACH.

Keywords: acrodermatitis continua of hallopeau; apremilast; combination; phosphodiesterase inhibitor; secukinumab.

Figure 1

Hyperkeratosis of the epidermis with parakeratosis, and neutrophils accumulate in the epidermis forming a pustule. Kogoj microabscess is seen above the spinous layer. (HE ×100).

Figure 2

Obvious turbidity and thickening of the nail, with several pustules underneath the nail. (a and b) The normal nail had grown from the left side of the nail at week 24. (c and d) Complete clearance of pustules and erythema was achieved at week 48. The form of the nascent deck was normal (e and f).