Turkderm-Turk Arch Dermatol Venereol. 2017; 51(4): 133-136 | DOI: 10.4274/turkderm.73880

Topikal takrolimus ile tedavi edilen bir akrodermatitis kontinua Hallopeau olgusu ve literatüre yeniden bakýþ

Fatih Göktay¹, Zeynep Büþra Küçüker², Pembegül Güneþ³, Levent Soydan⁴, Sema Aytekin^1
1Saðlýk Bilimleri Üniversitesi, Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Dermatoloji Ana Bilim Dalý, Ýstanbul, Türkiye
²Saðlýk Bakanlýðý Ankara Eðitim ve Araþtýrma Hastanesi, Dermatoloji Ana Bilim Dalý, Ankara, Türkiye
³Saðlýk Bilimleri Üniversitesi, Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Patoloji Ana Bilim Dalý, Ýstanbul, Türkiye
⁴Saðlýk Bilimleri Üniversitesi, Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Radyoloji Ana Bilim Dalý, Ýstanbul, Türkiye

Akrodermatitis kontinua Hallopeau (AKH) akral bölgelere lokalize eritem ve püstüler lezyonlar ile karakterize kronik ve tekrarlayýcý enflamatuvar bir hastalýktýr. Bu hastalarda týrnak distrofisi, matriks hasarý, anoniþi ve kemik-eklem deformasyonlarý görülebilir. Spontan remisyon nadir olup AKH’nin tedavisinde kullanýlan terapötik ajanlarýn çoðu ile uzun süreli remisyon saðlanmasýnýn zor olduðu gösterilmiþtir. Kortikosteroidler, katran, ditranol, fluorourasil, kalsipotriol ve takrolimus AKH’nin topikal tedavisinde deðiþen baþarý oranlarý ile kullanýlmýþtýr. Buradaki olguda, sol el baþparmakta topikal kortikosteroide dirençli AKH günde iki kez sadece açýk uygulanan topikal takrolimus ile baþarýlý þekilde tedavi edildi. Ýlacýn uygulama sýklýðý giderek azaltýldý. Yedi buçuk aylýk takibin sonunda tama yakýn iyileþme görüldü, ancak hastada, haftada bir kez uygulanan tedavi protokolünün 21. haftasýnda ilaç kullanýmýna devam ederken rekürrens izlendi. Bu aþamada, gündüz açýk uygulanan ve gece kapatýlan takrolimus ve intralezyonel triamsinolon asetonid enjeksiyonu etkili olmadý. Hastalýk daha sonra topikal uygulanan kalsipotriol ve klobetasol ile kontrol altýna alýnabildi.

Anahtar Kelimeler: Takrolimus, akrodermatitis-kontinua-Hallopeau, tedavi

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Topical tacrolimus for the treatment of acrodermatitis continua of Hallopeau: A case report and review of the literature

Fatih Göktay¹, Zeynep Büþra Küçüker², Pembegül Güneþ³, Levent Soydan⁴, Sema Aytekin^1
1University of Health Sciences, Haydarpaþa Numune Training and Research Hospital, Department of Dermatology, Ýstanbul, Turkey
²University of Health Sciences, Ankara Training and Research Hospital, Department of Dermatology, Ankara, Turkey
³University of Health Sciences, Haydarpaþa Numune Training and Research Hospital, Department of Pathology, Istanbul, Turkey
⁴University of Health Sciences, Haydarpaþa Numune Training and Research Hospital, Department of Radiology, Ýstanbul, Turkey

Acrodermatitis continua of Hallopeau (ACH) is a chronic and recurrent inflammatory disorder characterized by erythema and pustular lesions localized on the acral regions. Nail dystrophy, matrix destruction, anonychia, and bone and joint deformation may be seen in patients with ACH. Spontaneous remission is rare, and it has proved difficult to achieve long-lasting remission with most of the therapeutic agents used in the treatment of ACH. Corticosteroids, tar, dithranol, fluorouracil, calcipotriol, and tacrolimus have been used in the topical treatment of ACH with variable success. In the present case, initially, topical corticosteroid-resistant ACH localized on the left thumb was successfully treated with open applied topical tacrolimus ointment alone twice daily. Application frequency of the agent was tapered gradually. There was near-complete healing at the end of 7.5 months of follow-up, but at the end of the 21 weeks of once-weekly therapy regimen, recurrence was observed. At this stage, topical daily open-applied and overnight occlusive treatment with tacrolimus and intralesional triamcinolone acetonide injection was ineffective. Then, the disease could be controlled with the topically applied calcipotriol and clobetasol.

Keywords: Tacrolimus, acrodermatitis-continua-Hallopeau, treatment

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