A woman in her fifties presented with pustules on her right thumb and left index finger (Figure 1). She reported picking the affected skin, which subsequently worsened the condition over one year. There was no personal or family history of psoriasis. Her condition improved with topical clobetasol propionate, calcipotriol and avoidance of trauma. Her hands worsened several months later, and plaque-type psoriasis developed on her body, requiring methotrexate (15 mg/wk). After several months of treatment with methotrexate, she stopped the medication because of adverse effects and minimal response. She was not interested in pursuing any further systemic treatment at the time.
Acrodermatitis continua (of Hallopeau) is a rare variant of pustular psoriasis. Disease incidence is difficult to estimate given the rarity of...