{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:02:05Z","timestamp":1784869325128,"version":"3.55.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Acrodermatitis continua of Hallopeau (ACH) is a rare and chronic variant of pustular psoriasis characterized by sterile pustules, periungual inflammation, and progressive nail destruction. Due to its rarity and overlapping clinical features with other nail disorders, ACH is frequently underrecognized and remains difficult to treat, with no standardized therapeutic guidelines. Here, we report a case of long-standing, isolated ACH showing marked improvement after treatment with the selective Janus kinase 1 (JAK1) inhibitor upadacitinib. A 54-year-old man presented with a 13-year history of recurrent periungual erythema, sterile pustules, and progressive nail dystrophy affecting multiple digits. The disease was refractory to topical corticosteroids, systemic antibiotics, acitretin, and 1\u202fyear of secukinumab therapy. Following initiation of upadacitinib 15\u202fmg daily, rapid clinical improvement was observed within 4\u202fweeks, with reduction of subungual pustules and periungual inflammation. Nail involvement subsequently improved gradually, accompanied by nail regrowth and a decrease in the modified Nail Psoriasis Severity Index score from 66 at baseline to 16 at week 24 and 13 at month 9. No adverse or unanticipated events were observed during follow-up. This case highlights the potential role of JAK1 inhibition as an effective therapeutic strategy for refractory ACH and supports further investigation into JAK-targeted therapies in pustular psoriasis spectrum disorders.<\/jats:p>","DOI":"10.3389\/fmed.2026.1868846","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:22:44Z","timestamp":1784866964000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Marked improvement of isolated acrodermatitis continua of hallopeau with upadacitinib: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Man","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hematology and Rheumatology, Longyan Second Hospital","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-Xiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Lan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hematology and Rheumatology, Longyan Second Hospital","place":["Longyan, China"]},{"name":"Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Yi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Hematology and Rheumatology, Longyan Second Hospital","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/j.jaad.2025.05.1438","article-title":"Acrodermatitis continua of Hallopeau-clinical review and proposed management algorithm","volume":"93","author":"Iorizzo","year":"2025","journal-title":"J Am Acad Dermatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1111\/exd.14805","article-title":"Acrodermatitis continua of Hallopeau and generalised pustular psoriasis: should they be the same or different entities?","volume":"32","author":"Chularojanamontri","year":"2023","journal-title":"Exp Dermatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1001\/jamadermatol.2021.0045","article-title":"Inhibition of progression of Acrodermatitis continua of Hallopeau with Baricitinib","volume":"157","author":"Han","year":"2021","journal-title":"JAMA Dermatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2316239","DOI":"10.1080\/09546634.2024.2316239","article-title":"Successful treatment of Acrodermatitis continua of Hallopeau by Tyk2 inhibitor with every other 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Dermatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"640","DOI":"10.7555\/jbr.38.20240090","article-title":"Targeted therapy outcomes in Acrodermatitis continua of Hallopeau: a systematic review","volume":"38","author":"Zhou","year":"2024","journal-title":"J Biomed Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1525821","DOI":"10.3389\/fimmu.2025.1525821","article-title":"Acrodermatitis continua of Hallopeau: a review and update on biological and small molecule targeted immunomodulatory therapies","volume":"16","author":"Sun","year":"2025","journal-title":"Front Immunol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"8285","DOI":"10.3389\/fimmu.2024.1338285","article-title":"Successful treatment of acrodermatitis continua of Hallopeau coexisting with generalized pustular psoriasis with spesolimab: a case report","volume":"15","author":"Wen","year":"2024","journal-title":"Front Immunol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1001\/jamadermatol.2023.6349","article-title":"Spesolimab response in a girl with Acrodermatitis continua of Hallopeau","volume":"160","author":"Wang","year":"2024","journal-title":"JAMA Dermatol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1093\/ced\/llae443","article-title":"Rapid improvement in refractory Acrodermatitis continua of Hallopeau with Spesolimab injection","volume":"50","author":"He","year":"2025","journal-title":"Clin Exp Dermatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.3389\/fimmu.2024.1440102","article-title":"Case report: successful treatment with spesolimab of acrodermatitis continua of Hallopeau in an older patient without IL36RN mutations","volume":"15","author":"Zheng","year":"2025","journal-title":"Front Immunol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1038\/s41392-023-01655-6","article-title":"Signaling pathways and targeted therapies for psoriasis","volume":"8","author":"Guo","year":"2023","journal-title":"Signal Transduct Target Ther"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s41927-018-0031-x","article-title":"In vitro and in vivo characterization of the Jak1 selectivity of Upadacitinib (Abt-494)","volume":"2","author":"Parmentier","year":"2018","journal-title":"BMC rheumatology"}],"container-title":["Frontiers in 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