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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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2
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Abduljawad M, Alsharif TH, Gronfula AG, Magadmi TK, Khayat LI, Fageeh SM, Almuallim AA, Mohammad MA, Albadri A. The Effectiveness of Anti-Interleukin-17A Treatment for Pityriasis Rubra Pilaris: A Systematic Review. Cureus 2023; 15:e41125. [PMID: 37519579 PMCID: PMC10382908 DOI: 10.7759/cureus.41125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Anti-interleukin-17A (anti-IL-17A) therapy has been increasingly employed as a treatment option for pityriasis rubra pilaris (PRP). In this study, we reviewed all available studies on this topic in the literature to evaluate the efficacy and safety of anti-IL-17A. Our main objective was to assess the current evidence on the efficacy and safety of anti-IL-17A therapy in the management of PRP. We searched for relevant articles on PubMed, MEDLINE, Ovid, Embase, and the Web of Science electronic databases from inception until 2022. Our inclusion criteria were as follows: randomized controlled trials (RCTs), quasi-randomized trials, or prospective observational studies that include PRP patients treated with biological treatments; studies that report clinical outcomes; and studies that compare the treatment modalities, including anti-IL-17, in the English language. A total of 19 articles involving 77 cases were reviewed after applying the inclusion criteria and removing duplicates. We found that type 1 PRP was the most common condition irrespective of gender, and the trunk was the most affected area. The study showed that IL-17 inhibitors had a significant impact on the patients. However, higher-level studies are required to further evaluate the therapeutic and safety effects of the treatment.
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Affiliation(s)
| | | | - Amin G Gronfula
- Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Talah K Magadmi
- Medicine and Surgery, King Abdulaziz University, Jeddah, SAU
| | | | - Sarah M Fageeh
- Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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3
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Ye L, Wu Z, Li C, Zhao X, Wan M, Wang L. Off-label uses of ustekinumab. Dermatol Ther 2022; 35:e15910. [PMID: 36208443 DOI: 10.1111/dth.15910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/18/2022] [Accepted: 10/06/2022] [Indexed: 11/27/2022]
Abstract
Ustekinumab (brand name Stelara®) is a human interleukin-12 and -23 antagonist and has been indicated for the treatments of moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease and ulcerative colitis. This review aims to synthesize and interpret the literature evaluating the off-label uses of ustekinumab. We performed searches in PubMed and ClinicalTrials.gov for clinical trials, observational studies, case series, and case reports evaluating label uses of ustekinumab. Studies evaluated the efficacy of ustekinumab for the following conditions: other types of psoriasis (expect plaque psoriasis and psoriatic arthritis), pityriasis rubra pilaris, hidradenitis suppurativa, atopic dermatitis, pyoderma gangrenosum, et al. Based on the available literature, ustekinumab appears to be a potential treatment choice for many other diseases. However, more clinical trials data are needed to adequately assess the safety and efficacy of ustekinumab for the treatment of these conditions.
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Affiliation(s)
- Lihua Ye
- Department of Dermatology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Zhenfei Wu
- Department of Dermatology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Changrong Li
- Medical Cosmetology Clinic, Hainan Yilimei Medical Cosmetology Co., Haikou, China
| | - Xiaoxia Zhao
- Department of Dermatology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Mengjie Wan
- Department of Dermatology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Li Wang
- Department of Dermatology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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4
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Gamonal SBL, Marques NCV, Pereira HMB, Gamonal ACC. Pityriasis rubra pilaris (type I) following administration of the BNT162b2 mRNA COVID-19 vaccine: Successful treatment with ustekinumab and acitretin. Dermatol Ther 2022; 35:e15899. [PMID: 36196603 PMCID: PMC9874643 DOI: 10.1111/dth.15899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/04/2022] [Accepted: 10/01/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Shirley Braga Lima Gamonal
- Department of Dermatology, Faculty of MedicineFederal University of Juiz de Fora (UFJF)Juiz de ForaBrazil
| | | | - Heitor Motta Bini Pereira
- Department of DermatologySchool of Medical Sciences and Health of Juiz de Fora (FCMS/JF)Juiz de ForaBrazil
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5
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DeBiasio C, Cyr J, Ayroud Y, Glassman SJ. A case of classic adult pityriasis rubra pilaris successfully treated with a combination of acitretin and ustekinumab: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221093453. [PMID: 35465019 PMCID: PMC9021576 DOI: 10.1177/2050313x221093453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Classic adult pityriasis rubra pilaris is a severe papulosquamous disease that tends to resolve in 3-5 years but can have a devastating impact on patients while active. It shares features with psoriasis, but treatment remains largely empiric, based on case reports and series. The condition is often refractory to treatment, especially initially, with topical corticosteroids and oral acitretin the more commonly employed agents. Relatively high doses of acitretin are needed for adequate response, and adverse events often limit adherence. Given the similarity to psoriasis, biologic agents approved for psoriasis have been used with good effect in classic adult pityriasis rubra pilaris and show better tolerance than other agents. In this report, we describe the successful use of a combination of acitretin and ustekinumab in a case of classic adult pityriasis rubra pilaris.
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Affiliation(s)
- Celina DeBiasio
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Janelle Cyr
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Yasmine Ayroud
- Department of Anatomical Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven J Glassman
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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6
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Frare CP, Blumstein AJ, Paller AS, Pieretti L, Choate KA, Bowcock AM, Larralde M. CARD14-associated papulosquamous eruption (CAPE) in pediatric patients: Three additional cases and review of the literature. Pediatr Dermatol 2021; 38:1237-1242. [PMID: 34448248 PMCID: PMC8578307 DOI: 10.1111/pde.14779] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CARD14-associated papulosquamous eruption (CAPE) is a proposed term that encompasses features ranging from psoriasis to pityriasis rubra pilaris (PRP) in association with CARD14 mutations. The early onset of the disease, prominent facial involvement, family history of an autosomal dominant trait, and poor response to conventional treatment are characteristics of CAPE that distinguish it from classical psoriasis and PRP. We describe the clinical features, family history, and response to therapy in three unrelated children with CAPE and compare these characteristics with those of previously described pediatric patients. Testing for CARD14 mutations in children with early onset of features of psoriasis or pityriasis rubra pilaris and resistance to conventional therapy should be considered.
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Affiliation(s)
- Cindy P Frare
- Department of Dermatology, Hospital Alemán, Buenos Aires, Argentina
| | - Alli J Blumstein
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lia Pieretti
- Dr Úraga Private Center for Skin Diseases, Guayaquil, Ecuador
| | - Keith A Choate
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Anne M Bowcock
- Dermatology, Oncological Sciences and Genetics & Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margarita Larralde
- Department of Dermatology, Hospital Alemán, Buenos Aires, Argentina.,Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
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7
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Rawal S, Kianian S, Guo W, Marquez J, Ayasse M, Siamas KA, Lee Y, Salvemini J. Alternative uses of ustekinumab for non-indicated dermatological conditions: a systematic review. Arch Dermatol Res 2021; 314:503-514. [PMID: 34156549 DOI: 10.1007/s00403-021-02262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 12/23/2022]
Abstract
Ustekinumab is approved for the treatment of psoriasis and Crohn's disease. Because many dermatological conditions are due to immune-mediated development, ustekinumab may be effective in other conditions. A systematic review of the off-label uses of ustekinumab, as well as on-label adverse effect, was performed, reporting on clinical improvement. MEDLINE, Embase, Web of Science, and Cochrane databases were searched for studies regarding ustekinumab treatment of rativa (HS), lichen planus (LP), pyoderma gangrenosum (PG), pityriasis rubra pilaris (PRP), cutalopecia areata (AA), atopic dermatitis (AD), Bechet's disease, bullous pemphigoid (BP), hidradenitis suppuaneous sarcoidosis, cutaneous systemic lupus erythematosus (SLE), and vitiligo. Descriptive statistics were performed. 74 articles of 4596 screened were included, and reported on 212 patients receiving ustekinumab treatment. Across all studies, ustekinumab showed promise in treating patients: AA (10/12 patients; 83.3% improvement), AD (28/74 patients; 37.8% improvement), HS (42/52 patients; 80.8% improvement), and PRP (25/27 patients; 92.6% improvement), among others. Adverse events were noted with the use of ustekinumab, including development of AA (four patients), AD (three patients), and BP (four patients), among others. Ustekinumab can be a promising option for patients with dermatological conditions refractory to traditional therapies. Adverse events must be monitored in certain patients.
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Affiliation(s)
- Sahil Rawal
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
| | - Sara Kianian
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - William Guo
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Jocellie Marquez
- Division of Plastic and Reconstructive Surgery at Stony, Brook University Hospital, Stony Brook, NY, USA
| | - Marissa Ayasse
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Katherine A Siamas
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Yoojin Lee
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Joann Salvemini
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
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8
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Haynes D, Strunck JL, Topham CA, Ortega-Loayza AG, Kent G, Cassidy PB, Hu R, Choate K, Wang Z, Liu Y, Greiling TM. Evaluation of Ixekizumab Treatment for Patients With Pityriasis Rubra Pilaris: A Single-Arm Trial. JAMA Dermatol 2021; 156:668-675. [PMID: 32293641 DOI: 10.1001/jamadermatol.2020.0932] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pityriasis rubra pilaris is a rare and disabling cutaneous disease that is frequently recalcitrant to conventional therapies and appears to involve interleukin (IL)-17 overexpression. Objective To investigate the clinical response and safety of ixekizumab in treating pityriasis rubra pilaris. Design, Setting, and Participants Single-arm, investigator-initiated trial conducted in adult patients with moderate to severe pityriasis rubra pilaris at a single-center academic university from June 2018 to January 2020. A total of 41 patients were screened, 12 were enrolled, and 11 completed the full duration of therapy. A referred, consecutive sample was used during participant selection. The treatment period and primary outcome occurred over 24 weeks with additional patient follow-up through 36 weeks. Intervention Subcutaneous administration of ixekizumab, a humanized IgG4 antibody that binds IL-17A, at the US Food and Drug Administration-approved dosing schedule for treatment of psoriasis for 24 weeks. Main Outcomes and Measures The primary outcome was the mean change in Psoriasis Area and Severity Index at 24 weeks. Secondary outcomes included change in affected body surface area, quality of life, induction of sustained remission, and association of improvement with CARD14 genetic variations and cutaneous cytokine expression. Results A total of 12 white patients (mean [SD] age, 49.8 [15.1] years; 8 male [67%]) were enrolled between June 2018 and April 2019, with 11 completing the full course of intervention. The mean (SEM) improvements in Psoriasis Area and Severity Index, affected body surface area, and Dermatology Life Quality Index were 15.2 (2.1) (P < .0001), 29.8% (9.3%) (P = .009), and 9.5 (2.5) (P = .004), respectively. The 4 participants with the most improvement in Psoriasis Area and Severity Index at week 24 stayed in remission at week 36 (defined as lack of increase in Psoriasis Area and Severity Index from week 24 through week 36), off therapy. Relative dermal IL-17A expression decreased by a 1.9 log-fold change. No participants had known pathogenic CARD14 variations. There were no serious adverse events. Conclusions and Relevance In this single-armed trial, ixekizumab was associated with reduced clinical signs and symptoms of pityriasis rubra pilaris in a subset of patients, including those in whom other systemic therapies have failed. Trial Registration ClinicalTrials.gov Identifier: NCT03485976.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Jennifer L Strunck
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Christina A Topham
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | | | - Gail Kent
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Pamela B Cassidy
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Ronghua Hu
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Keith Choate
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Zhiping Wang
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Yuangang Liu
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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9
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Liu T, Li S, Ying S, Tang S, Ding Y, Li Y, Qiao J, Fang H. The IL-23/IL-17 Pathway in Inflammatory Skin Diseases: From Bench to Bedside. Front Immunol 2020; 11:594735. [PMID: 33281823 PMCID: PMC7705238 DOI: 10.3389/fimmu.2020.594735] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Interleukin-17 (IL-17) is an essential proinflammatory cytokine, which is mainly secreted by the CD4+ helper T cells (Th17 cells) and subsets of innate lymphoid cells. IL-17A is associated with the pathogenesis of inflammatory diseases, including psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Interleukin-23 (IL-23) plays a pivotal role in stimulating the production of IL-17 by activating the Th17 cells. The IL-23/IL-17 axis is an important pathway for targeted therapy for inflammatory diseases. Emerging evidence from clinical trials has shown that monoclonal antibodies against IL-23, IL-17, and tumor necrosis factor are effective in the treatment of patients with psoriasis, atopic dermatitis, hidradenitis suppurativa, pityriasis rubra pilaris, pemphigus, and systemic sclerosis. Here, we summarize the latest knowledge about the biology, signaling, and pathophysiological functions of the IL-23/IL-17 axis in inflammatory skin diseases. The currently available biologics targeting the axis is also discussed.
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Affiliation(s)
- Taoming Liu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuni Ying
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwei Ding
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yali Li
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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10
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Kalogeropoulos CI, Papathanasiou KA, Tsagkaraki I, Giannopoulos G, Bamias A, Boutati EI. A Case of Meningococcal and HSV-2 Meningitis in a Patient Being Treated with Ustekinumab for Pityriasis Rubra Pilaris. Eur J Case Rep Intern Med 2020; 7:001615. [PMID: 32789127 PMCID: PMC7417051 DOI: 10.12890/2020_001615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/11/2020] [Indexed: 12/03/2022] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory papulosquamous dermatosis affecting both adults and children. Six subtypes of PRP have been described. Recently, the management of PRP with biologic immunosuppressive agents regularly used in psoriasis has been supported by several case reports and series. Ustekinumab is an anti-IL12/23 IgG1 kappa human monoclonal antibody. It has been approved for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis and ulcerative colitis. It has also been reported to be effective as an off-label treatment for PRP. Current data are equivocal regarding infectious disease risk with ustekinumab administration. We describe a case of meningococcal and HSV-2 infection of the central nervous system in a patient being treated with ustekinumab for PRP.
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Affiliation(s)
- Charalampos I Kalogeropoulos
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A Papathanasiou
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Ismini Tsagkaraki
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannopoulos
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristotelis Bamias
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni I Boutati
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
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11
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Ring NG, Craiglow BG, Panse G, Antaya RJ, Ashack K, Ashack R, Faith EF, Paller AS, McNiff JM, Choate KA, Ko CJ. Histopathologic findings characteristic of CARD14-associated papulosquamous eruption. J Cutan Pathol 2019; 47:425-430. [PMID: 31849081 DOI: 10.1111/cup.13633] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 10/24/2019] [Accepted: 12/05/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pathogenic mutations in caspase recruitment domain-containing protein 14 (CARD14) lead to CARD14-associated papulosquamous eruption, which shares clinicopathologic findings with psoriasis and pityriasis rubra pilaris. We aimed to describe distinguishing histopathologic features of CARD14-associated papulosquamous eruption. METHODS This retrospective study examined the histopathologic features of specimens from patients with confirmed CARD14-associated papulosquamous eruption and adult patients with plaque psoriasis and pityriasis rubra pilaris. RESULTS Lesional skin biopsies from patients with CARD14-associated papulosquamous eruption consistently showed alternating checkerboard parakeratosis and orthokeratosis, acanthosis without acantholysis, and dilated vessels in the dermal papillae, with some cases also showing follicular plugging. CONCLUSION CARD14-associated papulosquamous eruption has a range of findings, with a predominance of features typically associated with pityriasis rubra pilaris.
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Affiliation(s)
- Nan G Ring
- Department of Dermatology, Yale University, New Haven, Connecticut
| | | | - Gauri Panse
- Department of Dermatology, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut
| | - Richard J Antaya
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Kurt Ashack
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Richard Ashack
- Dermatology Associates of West Michigan, Grand Rapids, Michigan
| | - Esteban F Faith
- Department of Pediatrics and Dermatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Amy S Paller
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer M McNiff
- Department of Dermatology, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut
| | - Keith A Choate
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Christine J Ko
- Department of Dermatology, Yale University, New Haven, Connecticut.,Department of Pathology, Yale University, New Haven, Connecticut
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12
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Naidoo A, Sibbald C, Fleming PJ, Piguet V. Use of Biologics in Pityriasis Rubra Pilaris Refractory to First-Line Systemic Therapy: A Systematic Review [Formula: see text]. J Cutan Med Surg 2019; 24:73-78. [PMID: 31691587 DOI: 10.1177/1203475419887731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pityriasis rubra pilaris (PRP) is an uncommon, inflammatory, papulosquamous skin disease. Treatment of PRP is challenging as the disease is often refractory to conventional therapies, such as retinoids and methotrexate. There has been an increasing number of studies reporting the successful use of biologic therapy in patients with PRP; however, the data on the efficacy and safety are limited. Our objective was to evaluate the existing evidence for utilizing biologics, whether alone or in combination with established systemic therapies, in patients with treatment-resistant PRP. We systematically reviewed evidence within Medline and Pubmed databases between January 1, 2000, to March 31, 2019. Articles consisted of patients diagnosed with PRP who have failed to respond sufficiently to first-line systemic therapies, or who had comorbidities that precluded their use. In total, 363 unique articles were identified, 56 of which were considered relevant to the clinical question. Of the 56 articles highlighted, 35 met the inclusion criteria and were limited to case series and case studies. Therapy with biologics was found to be successful for both monotherapy (81.1% [27/33]) and when used in combination with existing systemic therapies (87.5% [14/16]). The existing evidence suggests that biologics may be regarded as a tool for PRP treatment alone or in combination therapy with existing treatments, although large-scale randomized clinical trials are necessary to better assess their efficacy and safety.
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Affiliation(s)
- Avee Naidoo
- 12366 210484 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Cathryn Sibbald
- 6567 Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick J Fleming
- 12366 210484 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Vincent Piguet
- 12366 210484 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,7938 Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
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Maloney NJ, Kim MM, Nguyen KA, Hisaw LD, Worswick S. Patient experiences with biologics and apremilast in pityriasis rubra pilaris: A patient survey. Dermatol Ther 2019; 32:e13060. [DOI: 10.1111/dth.13060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Nolan J. Maloney
- Division of Dermatology, Department of MedicineDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Mindy M. Kim
- Division of Hematology and Oncology, Department of MedicineDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Kevin A. Nguyen
- Division of Dermatology, Department of MedicineDavid Geffen School of Medicine at UCLA Los Angeles California
| | - Lisa D. Hisaw
- Kaiser Permanente, Northern California Dermatology Oakland California
| | - Scott Worswick
- Department of DermatologyUniversity of Southern California Los Angeles California
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Abstract
The discoveries of new genes underlying genetic skin diseases have occurred at a rapid pace, supported by advances in DNA sequencing technologies. These discoveries have translated to an improved understanding of disease mechanisms at a molecular level and identified new therapeutic options based on molecular targets. This article highlights just a few of these recent discoveries for a diverse group of skin diseases, including tuberous sclerosis complex, ichthyoses, overgrowth syndromes, interferonopathies, and basal cell nevus syndrome, and how this has translated into novel targeted therapies and improved patient care.
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Matsuda T, Yamazaki F, Ueda-Hayakawa I, Kambe N, Okamoto H. Case of pityriasis rubra pilaris progressed to generalized erythroderma following blockade of interleukin-17A, but improved after blockade of interleukin-12/23 p40. J Dermatol 2018; 46:70-72. [DOI: 10.1111/1346-8138.14709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Tomoko Matsuda
- Department of Dermatology; Kansai Medical University; Hirakata Japan
| | - Fumikazu Yamazaki
- Department of Dermatology; Kansai Medical University; Hirakata Japan
| | | | - Naotomo Kambe
- Department of Dermatology; Kansai Medical University; Hirakata Japan
- Allergy Center; Kansai Medical University; Hirakata Japan
| | - Hiroyuki Okamoto
- Department of Dermatology; Kansai Medical University; Hirakata Japan
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16
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Type I pityriasis rubra pilaris treated with tumor necrosis factor inhibitors, ustekinumab, or secukinumab: A review. J Am Acad Dermatol 2018. [DOI: 10.1016/j.jaad.2018.02.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Wain T, Choy B, Satchell AC, Woods JA, Frew JW. Secukinumab in pityriasis rubra pilaris: A case series demonstrating variable response and the need for minimal clinical datasets. JAAD Case Rep 2018; 4:500-505. [PMID: 29984296 PMCID: PMC6031589 DOI: 10.1016/j.jdcr.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Tevi Wain
- Department of Dermatology, Concord Hospital, Sydney, Australia
| | - Bonita Choy
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | | | - Jane A Woods
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia.,University of New South Wales, Sydney, Australia
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18
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Napolitano M, Abeni D, Didona B. Biologics for pityriasis rubra pilaris treatment: A review of the literature. J Am Acad Dermatol 2018; 79:353-359.e11. [PMID: 29609014 DOI: 10.1016/j.jaad.2018.03.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 01/10/2023]
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease that is often refractory to conventional therapies. The off-label use of biologics, such as anti-tumor necrosis factor, anti-interleukin (IL) 12/IL-23, and anti-IL-17 agents, has been proven successful in the past 2 decades for PRP treatment. Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by performing PubMed and ClinicalTrials.gov searches. Sixty-eight articles met our selection criteria and are herein discussed. Out of 86 PRP patients, the vast majority were treated with anti-tumor necrosis factor, anti-IL-12/IL-23, or anti-IL-17 biologics, either alone or in combination therapy. A marked-to-complete response was observed in 50%-78%, a partial response in 11%-25%, and no or poor response in 11%-25%. This review has several limitations, including small sample sizes and the lack of shared study design criteria. In some instances, PRP might have resolved spontaneously. Further, the presence of concomitant therapy or the lack of detailed data on previous treatments, makes it difficult to strictly define a therapeutic role per se of specific biologics in PRP. This review shows that biologics may be regarded as a tool for PRP treatment alone or in combination therapy although clinical trials are needed to better assess their efficacy and safety.
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Affiliation(s)
- Monica Napolitano
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy.
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Disease Unit, I Dermatology Division, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
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19
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Craiglow BG, Boyden LM, Hu R, Virtanen M, Su J, Rodriguez G, McCarthy C, Luna P, Larralde M, Humphrey S, Holland KE, Hogeling M, Hidalgo-Matlock B, Ferrari B, Fernandez-Faith E, Drolet B, Cordoro KM, Bowcock AM, Antaya RJ, Ashack K, Ashack RJ, Lifton RP, Milstone LM, Paller AS, Choate KA. CARD14-associated papulosquamous eruption: A spectrum including features of psoriasis and pityriasis rubra pilaris. J Am Acad Dermatol 2018; 79:487-494. [PMID: 29477734 PMCID: PMC6098739 DOI: 10.1016/j.jaad.2018.02.034] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heterozygous mutations in caspase recruitment domain family member 14 gene (CARD14) have been shown to be associated with psoriasis and familial pityriasis rubra pilaris (PRP). Many subjects with CARD14 mutations display features of both disorders, which can result in diagnostic uncertainty. In addition, these eruptions are often recalcitrant to conventional psoriasis therapies such as methotrexate, oral retinoids, and tumor necrosis factor-α inhibitors. OBJECTIVE We sought to describe the clinical characteristics, family history, and response to therapy in subjects with papulosquamous eruptions due to mutations in CARD14. METHODS Subjects were referred for genetic testing as part of a registry of subjects with inherited disorders of keratinization. DNA was isolated from blood or saliva, and multiplex targeted sequencing or whole exome sequencing was performed. Clinical histories of subjects with CARD14 mutations were reviewed. RESULTS We identified 15 kindreds with CARD14-associated papulosquamous eruption (CAPE). Characteristic features of CAPE include early age of onset; prominent involvement of the cheeks, chin, and ears; family history of psoriasis or PRP; minimal response to conventional topical and systemic psoriasis therapies; and improvement with ustekinumab. LIMITATIONS Relatively small sample size. CONCLUSIONS Many subjects with CARD14 mutations display characteristics of both psoriasis and PRP. We propose the term CARD14-associated papulosquamous eruption to describe this spectrum of disease. Subjects with clinical features suggestive of CAPE should undergo CARD14 sequencing and may benefit from treatment with ustekinumab.
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Affiliation(s)
- Brittany G Craiglow
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Lynn M Boyden
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Ronghua Hu
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Marie Virtanen
- Department of Dermatology, Uppsala University Hospital, Uppsala, Sweden
| | - John Su
- Department of Dermatology, Monash University, Eastern Health, Melbourne, Australia; Department of Pediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Gabriela Rodriguez
- Department of Dermatology, University of Costa Rica, San Jose, Costa Rica
| | - Catherine McCarthy
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Paula Luna
- Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Margarita Larralde
- Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Stephen Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcia Hogeling
- Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California
| | | | - Bruno Ferrari
- Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Esteban Fernandez-Faith
- Department of Pediatrics and Dermatology, The Ohio State University Medical Center, Columbus, Ohio; Department of Pediatrics and Dermatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Beth Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California
| | - Anne M Bowcock
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genome Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard J Antaya
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Kurt Ashack
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Leonard M Milstone
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
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