|Comments from Faculty and Members
David Elpern MD, Williamstown, MA, USA on
Apr 27, 2005
This is a fascinating case. The localization mostly to the
great toes raises the question of external causes - iatrogenic
or factitial. This may explain why occlusion was helpful. "Sometimes,
it is more important to treat the patient who has the disease
than it is to treat the disease the patient has." Dr. McColl's
attention to this patient may have done more to help her than
the ingredients of the creams prescribed.
Shahbaz Janjua MD, Lalamusa, Pakistan on Apr
Acrodermatitis continua of Hallopeau seems to be a logical
conclusion after viewing the clinical pictures and knowing all
the test results. Subcorneal neutrophilic (sterile) pustules
on histopathology should have confirm this diagnosis especially
in the absence of any lesions of pustular psoriasis elsewhere.
In both the situations, she would be candidate for an aggressive
systemic therapy (acitretin or cyclosporin in my view) if she
did'nt respond to the topical therapy alone.
Haitam Alqari MD, New York, NY, USA on Apr
Hi, I guess with this type of presentation, sudden in onset,
painful, almost negative cultures specially virus (Herpes simples),
this could be a case of bilateral pyoderma gangrenosum. Even
though Acrodermatitis continua of Hallopeau can present in this
way, but usually painless unless it’s secondary infected.
Is the pt smoker? Just to role out Buerger's disease.
Amanda Oakley FRACP, Hamilton, New Zealand on
Apr 28, 2005
Lichen planus may rarely present like this. Biopsy of erosive
LP is frequently non-specific. I presented a case in 1985 at
the Annual Meeting of the BAD, in London - she lost all her
nails and was treated with oral steroids for years [OAKLEY A,
HARPER J, COPEMAN P. Ulcerative Lichen Planus of the Mouth and
Feet. Br J Derm 1985; 113: suppl 29, 63 - 64.]
Khalifa Shaquie MD, PhD, Professor of Dermatology,
College of Medicine, University of Baghdad, Baghdad, Iraq
on Apr 29, 2005
The picture is more in favour of pemphigus vegetans, Hallopeau
type rather than acrodermatitis continua. Please repeat the
biopsy from the active clean margin. Give oral steroids which
will be beneficial for all differential diagnoses that were