Successful etanercept therapy in therapy refractory acrodermatitis continua suppurativa Hallopeau

A 50-year-old patient presented with erythema, vesicles and pustules as well as interphalangeal joint pain. Acrodermatitis continua suppurativa Hallopeau was diagnosed. She was treated topically with glucocorticosteroids, calcitriol, calcipotriol, tacrolimus and bath-PUVA therapy without any clear benefit. Systemic acitretin 0.75 mg/kg daily led to improvement but complete resolution could never be achieved. Because of acitretin-induced mucosal side effects and hair loss, the dose was reduced to 20 mg/d alternating with 10 mg/d. The disease flared again. Additional therapy with etanercept 2 x 25 mg subcutaneously weekly was started. Within four weeks all symptoms resolved. The joint pain disappeared and the nail growth improved. After six months, etanercept therapy was discontinued. Two weeks later the first rebound of pustules occurred. Etanercept was restarted and the patient cleared rapidly. Etanercept therapy can be a useful therapeutic approach in refractory acrodermatitis continua suppurativa Hallopeau.