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Montero-Menárguez J, Amat Samaranch V, Puig Sanz L, Ruiz-Villaverde R, Arias-Santiago S, Larrea García M, Ruiz Genao D, Ferrán M, Schneller-Pavelescu L, Romero Ferreiro C, Rivera Díaz R. Pityriasis Rubra Pilaris: A Multicentric Case Series of 65 Spanish Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00526-X. [PMID: 38964605 DOI: 10.1016/j.ad.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/13/2023] [Accepted: 02/06/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians. OBJECTIVE To add our experience to increase evidence about PRP. METHODS We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP. RESULTS PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response. CONCLUSION Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.
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Affiliation(s)
- J Montero-Menárguez
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, España.
| | - V Amat Samaranch
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, España
| | - L Puig Sanz
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, España
| | - R Ruiz-Villaverde
- Dermatology Department of Hospital Universitario San Cecilio de Granada, España
| | - S Arias-Santiago
- Dermatology Department of Hospital Virgen de las Nieves de Granada, School of Medicine, Granada University, Instituto de Investigación Biosanitaria IBS, Granada, España
| | - M Larrea García
- Dermatology Department of Hospital Universitario de Navarra, España
| | - D Ruiz Genao
- Dermatology Department of Fundación Hospital Alcorcón, España
| | - M Ferrán
- Dermatology Department of Hospital del Mar de Barcelona, España
| | | | - C Romero Ferreiro
- Unidad de Soporte Científico, Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre, España; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - R Rivera Díaz
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, España
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Joshi TP, Duvic M. Pityriasis Rubra Pilaris: An Updated Review of Clinical Presentation, Etiopathogenesis, and Treatment Options. Am J Clin Dermatol 2024; 25:243-259. [PMID: 38159213 DOI: 10.1007/s40257-023-00836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
Pityriasis rubra pilaris (PRP) is a rare papulosquamous reaction pattern with a significant impact on quality of life. Type I PRP is the most common PRP variant, presenting as erythematous papules emerging in a follicular distribution and later coalescing into plaques with characteristic islands of sparing; histologically, an alternating pattern of orthokeratosis and parakeratosis is considered the hallmark of PRP (checkerboard hyperkeratosis). Other PRP variants (types II-V) differ in their age of onset and clinical presentation. Type VI PRP is a rare PRP subtype associated with human immunodeficiency virus infection and is occasionally associated with diseases of the follicular occlusion tetrad. Caspase recruitment domain family, member 14 (CARD14)-associated papulosquamous eruption and facial discoid dermatitis are newly described disease states that have an important clinical overlap with PRP, creating shared conundrums with respect to diagnosis and treatment. The etiology inciting PRP often remains uncertain; PRP has been suggested to be associated with infection, malignancy, or drug/vaccine administration in some cases, although these are based on case reports and causality has not been established. Type V PRP is often due to inborn CARD14 mutations. Furthermore, recent literature has identified interleukin-23/T-helper-17 cell axis dysregulation to be a major mediator of PRP pathogenesis, paving the way for mechanism-directed therapy. At present, high-dose isotretinoin, ixekizumab, and secukinumab are systemic agents supported by single-arm prospective studies; numerous other agents have also been trialed for PRP, with variable success rates. Here, we discuss updates on clinical manifestations, present new insights into etiopathogenesis, and offer a survey of recently described therapeutic options.
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Affiliation(s)
- Tejas P Joshi
- School of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Madeleine Duvic
- Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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3
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Montero-Menárguez J, Amat Samaranch V, Puig Sanz L, Ruiz-Villaverde R, Arias-Santiago S, Larrea García M, Ruiz Genao D, Ferrán M, Schneller-Pavelescu L, Romero Ferreiro C, Rivera Díaz R. Pityriasis Rubra Pilaris: A Multicentric Case Series of 65 Spanish Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00161-3. [PMID: 38401879 DOI: 10.1016/j.ad.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/13/2023] [Accepted: 02/06/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians. OBJECTIVE To add our experience to increase evidence about PRP. METHODS We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP. RESULTS PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response. CONCLUSION Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.
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Affiliation(s)
- J Montero-Menárguez
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - V Amat Samaranch
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, Spain
| | - L Puig Sanz
- Dermatology Department of Hospital de la Santa Creu i Sant Pau de Barcelona, Spain
| | - R Ruiz-Villaverde
- Dermatology Department of Hospital Universitario San Cecilio de Granada, Spain
| | - S Arias-Santiago
- Dermatology Department of Hospital Virgen de las Nieves de Granada, School of Medicine, Granada University, Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - M Larrea García
- Dermatology Department of Hospital Universitario de Navarra, Spain
| | - D Ruiz Genao
- Dermatology Department of Fundación Hospital Alcorcón, Spain
| | - M Ferrán
- Dermatology Department of Hospital del Mar de Barcelona, Spain
| | | | - C Romero Ferreiro
- Unidad de Soporte Científico, Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - R Rivera Díaz
- Dermatology Department of the Hospital Universitario 12 de Octubre, Madrid, Spain
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Guenther J, Novack D, Kamath S, Worswick S. Treatment Options for Juvenile Pityriasis Rubra Pilaris. Paediatr Drugs 2023; 25:151-164. [PMID: 36529810 DOI: 10.1007/s40272-022-00549-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Pityriasis rubra pilaris represents a group of familial and acquired disorders of cornification that affect both adult and pediatric patients. Treatment options are difficult to assess through clinical trials, given the rarity of the disorder and its tendency for spontaneous remission. Case reports and case series are therefore the primary means of assessment. Because of the heterogeneity of the disease, there is no universal approach to treatment, and multiple agents may need to be trialed to achieve disease control. At present, topicals are used for most pediatric patients, though monotherapy with topicals is only effective for less severe disease. Despite concerns over their side-effect profiles, oral retinoids are generally accepted as a first-line systemic therapy. However, interleukin-17 inhibitors and ustekinumab, an interleukin-12 and interleukin-23 inhibitor, may soon become first-line systemic treatment as well, given their efficacy and relative safety in trials thus far. Ustekinumab, in particular, is emerging as a first-line agent for patients with pityriasis rubra pilaris with CARD14 gene variations. When these therapies fail, second-line and adjunctive therapies to consider include tumor necrosis factor-alpha inhibitors, methotrexate, and phototherapy. However, further investigation is necessary to assess the safety and efficacy of many of these agents in juvenile pityriasis rubra pilaris.
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Affiliation(s)
- Jana Guenther
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Sonia Kamath
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott Worswick
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Albrakati BA, Alshareef IA, Alhawsawi WK, Al Hawsawi KA. Atypical Juvenile Pityriasis Rubra Pilaris: A Case Report of Early Onset With Late Diagnosis. Cureus 2022; 14:e30234. [DOI: 10.7759/cureus.30234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
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Grover C, Kharghoria G. Trachyonychia with Juvenile Pityriasis Rubra Pilaris. Indian Dermatol Online J 2021; 12:758-759. [PMID: 34667767 PMCID: PMC8456241 DOI: 10.4103/idoj.idoj_840_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/28/2020] [Accepted: 03/19/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chander Grover
- Department of Dermatology and Venereology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Geetali Kharghoria
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India
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Zegpi-Trueba MS, Navajas-Galimany L, González S, Ramírez-Cornejo C. Acute Postinfection Pityriasis Rubra Pilaris: Excellent Response to Emollients and Topical Corticosteroids. ACTAS DERMO-SIFILIOGRAFICAS 2021:S1578-2190(21)00164-5. [PMID: 34052140 DOI: 10.1016/j.adengl.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/12/2019] [Indexed: 10/21/2022] Open
Affiliation(s)
- M S Zegpi-Trueba
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Navajas-Galimany
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - C Ramírez-Cornejo
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Zegpi-Trueba MS, Navajas-Galimany L, González S, Ramírez-Cornejo C. Acute Postinfection Pityriasis Rubra Pilaris: Excellent Response to Emollients and Topical Corticosteroids. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:S0001-7310(20)30532-9. [PMID: 33307011 DOI: 10.1016/j.ad.2019.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- M S Zegpi-Trueba
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Navajas-Galimany
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - C Ramírez-Cornejo
- Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Kromer C, Sabat R, Celis D, Mössner R. Systemische Therapien bei Pityriasis rubra pilaris: eine systematische Übersicht. J Dtsch Dermatol Ges 2019; 17:243-260. [DOI: 10.1111/ddg.13718_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Christian Kromer
- Klinik für DermatologieVenerologie und AllergologieUniversitätsmedizin Göttingen Göttingen Deutschland
| | - Robert Sabat
- Interdisiplinäre Gruppe für Molekulare Immunpathologie, Dermatologie/Medizinische Immunologie, Charité – Universitätsmedizin Berlin Berlin Deutschland
- Psoriasis Forschungs‐ und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité – Universitätsmedizin Berlin Berlin Deutschland
| | - Daniel Celis
- Wirtschaftswissenschaftliche Fakultät, Universität Göttingen Göttingen Deutschland
| | - Rotraut Mössner
- Klinik für DermatologieVenerologie und AllergologieUniversitätsmedizin Göttingen Göttingen Deutschland
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Kromer C, Sabat R, Celis D, Mössner R. Systemic therapies of pityriasis rubra pilaris: a systematic review. J Dtsch Dermatol Ges 2018; 17:243-259. [PMID: 30520557 DOI: 10.1111/ddg.13718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/29/2018] [Indexed: 02/03/2023]
Abstract
Pityriasis rubra pilaris (PRP) is a rare papulosquamous disorder. Treatment is challenging; the armamentarium consists of topical corticosteroids, phototherapy, classic systemic treatments such as retinoids or immunosuppressive drugs, and most recently biologicals. However, the relative effectiveness of therapies is unclear. Our objective was to review the published literature on systemic treatment of PRP. A systematic review was conducted on PubMed and the Cochrane Library up to 5 September 2017. Studies evaluating any systemic treatments of PRP (except for historical treatments) were included. Overall, 182 studies met the predefined inclusion criteria, and reported on 475 patients and 652 courses of treatment. 42.0 % (225/514) of all patients treated with retinoids achieved an excellent response (isotretinoin: 61.1 % [102/167], etretinate: 47 % [54/115], and acitretin: 24.7 % [43/174]) compared to an excellent response rate of 33.1 % (53/160) with methotrexate. Therapy with biologicals was successful in 51.0 % of patients (71/133) (ustekinumab: 62.5 % [10/16], infliximab: 57.1 % [28/49], etanercept: 53.3 % [16/30], and adalimumab: 46.4 % [13/28]). This review balances effectiveness, side effects, experience, and drug costs in order to suggest a treatment regimen starting with isotretinoin as first-line, methotrexate as second-line and biologicals as third-line treatment for this difficult-to-treat dermatosis.
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Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Centre, Göttingen, Germany
| | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Department of Dermatology and Allergy and Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Celis
- Faculty of Economic Sciences, Göttingen University, Göttingen, Germany
| | - Rotraut Mössner
- Department of Dermatology, Venereology, and Allergology, University Medical Centre, Göttingen, Germany
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Abstract
Pityriasis rubra pilaris (PRP) is an idiopathic, papulosquamous inflammatory dermatosis. It is characterized by hyperkeratotic follicular papules coalescing into orange-red scaly plaques, islands of sparing, and palmoplantar keratoderma. PRP can be subdivided into six clinical subtypes according to Griffiths' classification, based on age of onset, disease extent, prognosis, and other associated features. The sixth subtype of PRP occurs in individuals affected by HIV infection, and retroviral screening in all de novo cases of PRP is advised. Other reported associations include various infections, autoimmunity, drugs, and malignancies, although the true significance of these is still unclear. The genetic basis for familial cases, most commonly categorized under the fifth subtype, has been mapped to gain of function mutations in the caspase recruitment domain family, member 14 (CARD14) gene. Treatment of PRP remains a challenge to this day due to a paucity of high-quality evidence. Therapeutic regimens have been guided mostly by case reports and case series, with the mainstay of treatment being oral retinoids. Recently, biologics have emerged as a promising treatment for PRP. We present a review of the clinicopathologic features, pathogenesis, associated disorders, and treatment of PRP, with an emphasis and critical appraisal of the existing literature on the latter.
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Abstract
Pityriasis rubra pilaris (PRP) is an uncommon papulosquamous dermatosis characterized by follicular, erythematous, hyperkeratotic papules coalescing to salmon-coloured plaques with islands of sparing. The disease tends to be self-limited and resolves spontaneously after a few years. In some cases, the disease is persistent. However, recurrence of this disease has rarely been described. An 8-year-old male was diagnosed with type III (classic juvenile) PRP. He was treated with acitretin, and his skin was clear after 6 months. He remained disease free for 6 years. At 14 years old, he was diagnosed again with type III PRP. His cutaneous manifestations were highly similar to his initial presentation. He was treated with acitretin and methotrexate concurrently and achieved skin clearance. Recurrence of type III PRP is possible although rarely described in the literature. Acitretin ± methotrexate therapy is effective at achieving skin clearance.
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Affiliation(s)
| | - Loretta Fiorillo
- 2 Pediatric Dermatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Bonomo L, Raja A, Tan K, Guttman-Yassky E. Successful treatment of juvenile pityriasis rubra pilaris with ustekinumab in a 7-year-old girl. JAAD Case Rep 2018; 4:206-210. [PMID: 29892668 PMCID: PMC5993550 DOI: 10.1016/j.jdcr.2017.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lauren Bonomo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aishwarya Raja
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kathryn Tan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
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Moretta G, De Luca EV, Di Stefani A. Management of refractory pityriasis rubra pilaris: challenges and solutions. Clin Cosmet Investig Dermatol 2017; 10:451-457. [PMID: 29184428 PMCID: PMC5687447 DOI: 10.2147/ccid.s124351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory papulosquamous skin disease. Its clinical presentation and evolution is very variable. The most frequent clinical features are follicular papules, progressing to yellow-orange erythroderma with round small areas of normal skin and the well-demarcated palmoplantar keratoderma. Actually, six different types of PRP have been described based on clinical characteristics, age of onset, and prognosis. The pathogenesis is still unknown, and treatment can be challenging. Available treatments are mainly based on case reports or case series of clinical experience because no controlled randomized trials have never been performed because of the rarity of the condition. Traditional systemic treatment consists in retinoids, which are actually considered as first-line therapy, but refractory cases that do not respond or relapse after drug interruption do exist. In recent years, numerous reports have demonstrated the efficacy of new agents such as biological drugs. This article is an overview on available therapeutic options, in particular for refractory forms of PRP.
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Affiliation(s)
- Gaia Moretta
- Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Erika V De Luca
- Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Di Stefani
- Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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Gemmeke A, Schönlebe J, Koch A, Wollina U. Pityriasis rubra pilaris--a retrospective single center analysis over eight years. J Dtsch Dermatol Ges 2010; 8:439-44. [PMID: 20202046 DOI: 10.1111/j.1610-0387.2010.07338.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pityriasis rubra pilaris (PRP) is a rare papulosquamous dermatosis. We evaluated evaluate co-morbidities, complications, and outcome of treatment regimens. PATIENTS AND METHODS This is a retrospective study at an academic teaching hospital. We analyzed all patients with the definite diagnosis of PRP seen since 2001. Epidemiologic data, co-morbidities, response to and course during treatment were investigated. RESULTS We identified 10 PRP-patients (6 men, 4 women), mean age 56.4 years, with type I (n = 9) and type IV (n = 1). Three patients had internal co-morbidities (atrial fibrillation with cardiac insufficiency, dilated cardiomyopathy, diabetes mellitus). Two patients needed psychiatric treatment because of depression. PRP caused ectropium (2 x), diffuse effluvium (1 x), and stenosis of the outer ear canal (1 x). We did not observe a spontaneous remission. Among 9 patients with PRP type I, five were treated with acitretin (two of them as Re-PUVA), and two with methotrexate (in one patient combined with fumaric acids). Systemic corticosteroids were not effective. One patient was treated with infliximab i.v., 5 mg/kg body weight. Starting with the first application, inflammatory activity decreased and erythema got paler. The treatment was well tolerated. CONCLUSIONS PRP type I is a severe, chronic inflammatory dermatosis responding hesitantly to classic systemic therapies. Tumor necrosis factor-alpha antagonists are an effective treatment option for difficult cases.
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Affiliation(s)
- Astrid Gemmeke
- Department of Dermatology and Allergology, Dresden-Friedrichstadt Hospital, Dresden, Germany
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Mazereeuw-Hautier J. Quoi de neuf en dermatologie pédiatrique ? Ann Dermatol Venereol 2009; 136 Suppl 7:S426-35. [DOI: 10.1016/s0151-9638(09)73384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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