| • | now classified as a form of acropustular psoriasis |
clinical:
| • | most often begins at the tips of one or two fingers (or less often toes) |
| • | nail folds are affected early |
| • | small pustules burst leaving an erythematous shiny area in which new pustules develop |
| • | as the disease extends proximally the affected area shows either glossy erythema or a crusted, keratotic, and fissured surface with newly formed pustules underneath |
course:
| • | chronic course, with a tendency of the lesions to spread proximally (hence the name “continua” – it ‘continues’ to spread proximally; and it ‘continues’ to persist – i.e. spontaneous improvement is rare) |
| • | may remain confined to original site, sometimes up to several years |
| • | the development of pustules at other sites, or even the eruption of generalized pustular psoriasis, supports the idea that acrodermatitis continua is a variant of psoriasis |
ddx:
| • | (early stage ddx) = acute paronychia |
| • | PPP or pustular dishydrotic eczema |
| • | atrophy and loss of nails do not occur in these diseases |
| • | the distal localization and the tendency of the pustules to become confluent, forming denuded, erythematous or crusted lesions distinguishes acrodermatitis continua |
| • | contact dermatitis with secondary infection – has less clearly defined margins, runs a different clinical course, and lacks the persistence |
treatment:
| • | no specific drug brings lasting remission; i.e. always relapse after drug is withdrawn (like psoriasis) |
| • | potent topical glucocorticoids (under occlusion) are useful in blocking pustulation |
| • | PUVA (i.e. treatment options similar to PPP and psoriasis) |
| • | try tetracycline 500PO QID and topical steroids under occlusion. |
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