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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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2
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Aromolo IF, Pisapia A, Riva D, Barberi F, Marzano AV, Moltrasio C, Romagnuolo M. COVID-19 induced pityriasis rubra pilaris: A superantigenic disease? J Eur Acad Dermatol Venereol 2022; 37:e26-e28. [PMID: 35993491 PMCID: PMC9538733 DOI: 10.1111/jdv.18556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Italo Francesco Aromolo
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly,Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Armando Pisapia
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly,Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Davide Riva
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly,Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Francesco Barberi
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly,Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Angelo Valerio Marzano
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly,Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Chiara Moltrasio
- Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Medical Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | - Maurizio Romagnuolo
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly,Dermatology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
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3
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Kadylak D, Barańska-Rybak W. Acute postinfectious pityriasis rubra pilaris as a cutaneous manifestation in COVID-19: a case report and its dermoscopic features. J Eur Acad Dermatol Venereol 2021; 35:e622-e624. [PMID: 34058019 PMCID: PMC8242759 DOI: 10.1111/jdv.17424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- D Kadylak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - W Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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4
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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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Aguilar-Gamboa FR, Cubas-Alarcon D, Villegas-Chiroque M, Failoc-Rojas VE. Pityriasis rubra pilaris post-infection due COVID-19: case report. Colomb Med (Cali) 2021; 52:e7014577. [PMID: 33911322 PMCID: PMC8054706 DOI: 10.25100/cm.v52i1.4577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.
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Affiliation(s)
- Franklin R Aguilar-Gamboa
- Hospital Regional Lambayeque, Laboratorio de inmunología y virología, Dirección de Investigación. Chiclayo, Perú. Hospital Regional Lambayeque Laboratorio de inmunología y virología Dirección de Investigación Chiclayo Perú
| | - Dennis Cubas-Alarcon
- Hospital Regional Docente Belén de Lambayeque, Laboratorio de Microbiología, Servicio de Laboratorio Clínico, Belén de Lambayeque, Perú. Hospital Regional Docente Belén de Lambayeque Laboratorio de Microbiología Servicio de Laboratorio Clínico Belén de Lambayeque Perú
| | - Miguel Villegas-Chiroque
- Hospital Regional Lambayeque, Servicio de Infectología, Chiclayo, Perú. Hospital Regional Lambayeque Servicio de Infectología Chiclayo Perú
| | - Virgilio E Failoc-Rojas
- Universidad San Ignacio de Loyola, Lima, Perú. Universidad San Ignacio de Loyola Universidad San Ignacio de Loyola Lima Peru
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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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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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Martin KL, Holland KE, Lyon V, Chiu YE. An unusual cluster of circumscribed juvenile pityriasis rubra pilaris cases. Pediatr Dermatol 2014; 31:138-45. [PMID: 24456130 DOI: 10.1111/pde.12260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Circumscribed juvenile pityriasis rubra pilaris (PRP) is an uncommon dermatosis. We describe the unusual clustering of circumscribed juvenile PRP cases in our pediatric dermatology clinic in 2011. A retrospective chart review was done of patients presenting during the summer of 2011 with classic findings of circumscribed juvenile PRP. Clinical data including past medical and family history, presenting symptoms, infectious disease history and evaluation, biopsy results, and management were recorded. Seven patients, ages 5 to 19 years, all had strikingly similar skin findings of pink to hyperpigmented, well-defined, scaly papules and plaques on their elbows, knees, dorsal hands, ankles, and Achilles tendons. Four of the seven also had palmoplantar involvement. Four were sibling pairs and the other three were unrelated. Streptococcus pyogenes infection was suspected as a trigger in four of the patients. The unusual clustering of this uncommon disease, along with the occurrence in two sibling pairs, suggests that a genetic susceptibility unmasked by an infectious agent may play a role in its pathogenesis.
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Affiliation(s)
- Kari L Martin
- Department of Dermatology, University of Missouri, Columbia, Missouri
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Pityriasis rubra pilaire après vaccination. Ann Dermatol Venereol 2011; 138:753-6. [DOI: 10.1016/j.annder.2011.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 01/06/2011] [Accepted: 01/27/2011] [Indexed: 11/20/2022]
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Gómez-Moyano E, Crespo-Erchiga A, Vera Casaño A, Sanz Trelles A. Pitiriasis rubra pilaris acantolítica durante tratamiento con imiquimod 5% crema. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gómez-Moyano E, Crespo-Erchiga A, Vera Casaño A, Sanz Trelles A. Pityriasis Rubra Pilaris With Focal Acantholytic Dyskeratosis During Treatment With Imiquimod 5% Cream. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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