Rapid Resolution of Pediatric Acrodermatitis Continua of Hallopeau With Spesolimab

Acrodermatitis continua of Hallopeau (ACH) is a sterile pustular psoriasis variant that is refractory to conventional therapies. The eruption typically develops following local trauma or infection, with other potential etiological factors including neural, inflammatory, and genetic origins. Notably, ACH is exceptionally rare in pediatric populations and presents significant therapeutic challenges owing to the safety limitations of conventional systemic therapies. A 7-year-old male patient with no personal or family history of psoriasis presented with recurrent episodes of erythema, edema, and pustule formation localized to the nail beds of 3 digits. Repeated microbiological analyses of pustular secretions, including mycological examinations, bacterial and/or atypical mycobacterial cultures, and viral tests, yielded negative results. Histopathology revealed parakeratosis, epidermal neutrophilic infiltrates, and ectatic dermal papillary vessels. Consequently, a diagnosis of ACH was established. After initial laboratory evaluations revealed no significant abnormalities, the patient received spesolimab at a dose of 450 mg (15 mg/kg) intravenously at weeks 0 and 1, with informed consent from the patient and his parents. Periungual inflammation resolved completely by week 8, accompanied by initiation of fingernail regrowth. No treatment-related adverse events occurred during therapy or follow-up. Our case report presents the successful application of spesolimab in a 7-year-old child with ACH, thus further supporting the potential of this targeted biologic agent in pediatric ACH treatment.