Acute postinfectious pityriasis rubra pilaris as a cutaneous manifestation in COVID-19: a case report and its dermoscopic features

Pityriasis Rubra Pilaris: An Updated Review of Clinical Presentation, Etiopathogenesis, and Treatment Options

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.

A Rare Post-infectious Rash: Pityriasis Rubra Pilaris After COVID-19 Infection

Pityriasis rubra pilaris (PRP) is a rare papulosquamous skin disorder that often presents with erythematous follicular-based hyperkeratotic papules that can become confluent and lead to erythroderma and electrolyte and thermoregulatory imbalances resulting from increased tissue perfusion and skin barrier breakdown. Due to this condition being uncommon, many specialties outside of dermatology are unfamiliar with this entity which poses unique diagnostic and management challenges. This case report involves a 55-year-old woman who presented to the emergency room with erythroderma secondary to PRP. It highlights the relevance of PRP in the context of in-hospital management by presenting the patient's clinical profile, diagnostic workup, and treatment plan. By emphasizing the distinctive clinical features and natural course of the disease, this report aims to enhance the understanding of this uncommon inflammatory skin condition.

Pityriasis Rubra Pilaris After Moderna COVID-19 Vaccination: A Case Report and Literature Review

ABSTRACT

To date, over 60% of the world's population has received at least 1 dose of coronavirus disease 2019 (COVID-19) vaccination, with over 12 billion doses administered globally. Commonly reported adverse effects of COVID-19 vaccination include fever, headache, myalgia, and injection site reactions. The spectrum of documented cutaneous reactions after COVID-19 vaccination is broad; however, pityriasis rubra pilaris (PRP) or PRP-like eruption secondary to COVID-19 vaccine is exceedingly rare, with only 17 cases previously reported to date in the English literature. In this article, we describe an additional case of COVID-19 vaccination-associated PRP in a 50-year-old woman with a history of metastatic breast carcinoma, who developed a widespread cutaneous eruption characteristic of PRP, including palmoplantar keratoderma, 10 days after her third dose of Moderna COVID-19 vaccine. Punch biopsy specimen showed epidermal hyperplasia with overlying hyperkeratosis, alternating orthokeratosis and parakeratosis and focal follicular plugging, supporting the diagnosis of PRP. The patient improved within weeks of initiating oral acitretin and topical steroids, with resolution achieved after 3 months of continued therapy. To the best of our knowledge, this is the third reported case of Moderna COVID-19 vaccination-associated PRP and collectively the 18 th after the administration of all COVID-19 vaccines currently available, including Pfizer-BioNTech, and AstraZeneca.

Pityriasis rubra pilaris (Devergie's disease) in a COVID-19 patient

Pityriasis rubra pilaris (Devergie's disease) is an idiopathic, papulosquamous inflammatory dermatosis characterized by progressive erythrodermia. The etiology of the disease is unknown, and most cases occur sporadically. Viral infections, impaired vitamin A metabolism, medications, autoimmune reactions, and malignancies are most common triggering factors. The diagnosis of Devergie's disease is based on the clinical manifestations of the disease and the results of a skin histological examination. The present paper discusses a clinical case of pityriasis rubra pilaris that occurred in a COVID-19, 40-year-old woman. For the purpose of differential diagnosis of pitiriasis with atopic dermatitis, erythrodermic form of psoriasis, generalized form of urticaria, it is necessary to perform immunohistochemical studies to identify the proliferation of immunocompetent cells. Based on the described clinical case, it seems possible to recommend testing for SARS-CoV-2 if a patient has Devergie's disease against the background of fever and intoxication syndrome.

[Pityriasis rubra pilaris after COVID-19 vaccination: causal relationship or coincidence?]

Seit der Markteinführung der COVID-19-Impfstoffe werden regelmäßig kutane Nebenwirkungen dieser Vakzine beschrieben. Diese beinhalten unter anderem lokale Impfreaktionen (insbesondere den sog. COVID-Arm), urtikarielle, makulopapulöse und pityriasiforme Exantheme oder vorübergehende Exazerbationen einer vorbestehenden chronisch entzündlichen Hauterkrankung. Wir berichten über 3 Fälle einer Pityriasis rubra pilaris, die in engem zeitlichen Zusammenhang mit der Verabreichung eines COVID-19-Impfstoffs erstmals aufgetreten sind.