Case Study Suzanne Acrodermatitis Continue

Suzanne is a 56-year-old female who suffers from acrodermatitis continia (L40.2), along with anxiety, arthritis, asthma and hypercholesterolemia. Her symptoms include painful, thickened, discolored and moderate in severity, dystrophic nails and cracked fingertips. Suzanne has tried and failed various treatments including olux, clobetasol and triamcinolone, which have provided her with little to no relief, despite months of treatment. Acrodermatitis continua of Hallopeau (ACH) is a rare inflammatory disease characterised by pustular eruptions beginning in the tips of fingers and toes (digits). The pustules may vary in extent over a chronic, recurrent course. Pustulation of the nail bed and its growth site (matrix) can result in onychodystrophy

(malformation) and anonychia (loss of nail). Slowly, the disease can spread proximally to affect the hand, forearm and/or foot. There may be osteolysis (destruction of bone) resulting in a wasted and tapered tip of finger or toe. The cause of acrodermatitis continua of Hallopeau is not completely understood. It is considered a variant of palmoplantar pustulosisand related to psoriasis. It is classified as an autoimmune disorder in which there is localized immune dysregulation in the skin. Although, Cosentyx is not approved for Suzanne’s diagnosis, the use of drugs for indications beyond those stipulated in the FDA label has been a physician prerogative that the FDA has approved of for more than 30 years, therefore Cosentyx is Suzanne’s best treatment option now, as she is unresponsive to aggressive topical therapy, additionally has extremely limited treatment options for her condition, therefore I am requesting an exception for coverage, as without this treatment, I fear Suzanne’s condition will continue to worsen causing increased and elevated pain and suffering, as well as an enormous effect on her daily living.