2025 ICD-10-CM code L40.2
Acrodermatitis continua of Hallopeau (ACH) is a rare inflammatory skin disease characterized by pustular eruptions on the tips of fingers and toes. It can lead to nail and bone damage if left untreated.
Medical necessity for treatment is based on the severity of symptoms, the impact on the patient's quality of life, and the potential for complications like nail loss and bone damage.Treatment is aimed at controlling inflammation, reducing pain, and preventing disease progression.
Diagnosis and management of ACH involves dermatologists, who are responsible for assessing the condition, performing necessary tests (such as skin biopsies to rule out other conditions), and developing a treatment plan.Treatment options can include topical medications (corticosteroids, calcipotriol, tacrolimus), systemic medications (methotrexate, cyclosporine, retinoids, biologics like anti-TNF agents, and IL-17 inhibitors), and phototherapy.
In simple words: Acrodermatitis continua of Hallopeau is a rare skin condition causing painful, pus-filled blisters on the fingertips and toes. It can also affect the nails and, in severe cases, the bones. This condition is a type of psoriasis and often starts after an injury or infection in the affected area.
Acrodermatitis continua of Hallopeau (ACH), also known as acrodermatitis continua suppurativa, acrodermatitis perstans, dermatitis perstans, acropustulosis, and dermatitis repens, is a chronic skin condition characterized by sterile pustules and underlying erythema primarily affecting the tips of fingers and toes. It is often triggered by local trauma or infection, but other etiologies, including neural and inflammatory causes, have been suggested.The pustules can coalesce and spread under the nail bed, leading to onychodystrophy (nail malformation) and anonychia (nail loss).As the disease progresses, hyperkeratosis and psoriasiform scaling can occur.In severe cases, ACH can cause osteitis and osteolysis of the distal phalanges. ACH is considered a localized form of pustular psoriasis. It predominantly affects middle-aged females, although it can occur in other demographics.
Example 1: A 45-year-old female presents with painful pustules and erythema on the tip of her right index finger, with associated nail discoloration. The lesions initially appeared after a minor cut to the finger.A skin biopsy confirms the diagnosis of ACH., A 60-year-old male with a history of psoriasis develops ACH on his left thumb. He experiences significant pain and nail dystrophy, requiring systemic treatment with a biologic agent., A child presents with pustular lesions on multiple fingertips.After ruling out other conditions like infection and eczema, a diagnosis of ACH is made, and the child is managed with topical medications.
Documentation should include detailed descriptions of the lesions (location, size, appearance), the presence of any nail involvement, history of trauma or infection to the affected area, and associated symptoms like pain or itching.Results of skin biopsies or other diagnostic tests should also be included.
- Specialties:Dermatology
- Place of Service:Office, Outpatient Hospital