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Zhou T, Al Muqrin A, Abu-Hilal M. Updates on Pityriasis Rubra Pilaris: A Scoping Review. J Cutan Med Surg 2024; 28:158-166. [PMID: 38174859 PMCID: PMC11015718 DOI: 10.1177/12034754231223159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Pityriasis rubra pilaris (PRP) is a rare, inflammatory papulosquamous skin disease with unknown exact etiology. Historically, PRP has been challenging to diagnose, especially during the acute phase, and to treat, due to its unclear pathogenesis. To better inform clinical practice, a literature review was conducted employing a broad search strategy to capture PRP-related published studies between January 1, 2012 to October 31, 2022. Two hundred twenty-one studies were identified, which were categorized into 9 themes: (1) potential causes and triggering factors, (2) comorbidities, (3) diagnostic difficulties, (4) genetics, (5) clinical manifestations and laboratory values, (6) treatment, (7) treatment-related adverse events, (8) quality of life, and (9) other. COVID-19 infection, COVID-19 vaccination, and malignancy were the most commonly reported potential triggering factors. Misdiagnosis is very common during the early acute stages. Pathogenesis and genetic studies have further implicated caspase recruitment domain family member 14 (CARD14) mutations in the development of familial PRP (Type V) and have underlined the overlap between psoriasis and PRP. To date, there are currently no specific and validated scoring systems or tools to assess the severity of PRP. While large, randomized trials are still lacking, biologic agents remain the most effective therapy.
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Affiliation(s)
- Ted Zhou
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Abdullah Al Muqrin
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohannad Abu-Hilal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Katkova KV, Plieva KT, Denisova EV, Zhukova OV, Korsunskaya IM. Itchy scalp. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.8.201809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Itchy scalp troubles many people. The causes of itching can be systemic, psychogenic, neurological, and dermatological diseases. The most common dermatological diseases associated with scalp itching are seborrheic dermatitis and psoriasis. The pathogenesis of these diseases is very different, but in both cases, skin microbiota changes may present, supporting the inflammation. Also, in both conditions, flaking and other similar clinical presentations occur. In addition to adequate therapy, the choice of care product is important. For a patient with scalp disease, the specialist should recommend shampoo and other products that can complement the basic therapy. Such products should have some features: they should help to normalize the microbiota and pH, relieve inflammation, and eliminate unpleasant symptoms, including itching. One such product is LE SANTI shampoo, which shows good clinical efficacy for several dermatological diseases.
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Fernandez-Flores A, Hermosa-Gelbard A, Novo-Lens R. Lichen-planopilaris-like scarring pattern in a patient with alopecia and pityriasis rubra pilaris. J Cutan Pathol 2020; 48:133-139. [PMID: 32949041 DOI: 10.1111/cup.13879] [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: 03/16/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
Pityriasis rubra pilaris (PRP) is an erythematous-desquamative dermatitis that is sometimes associated with non-scarring alopecia. Despite the fact that the disease can be disfiguring, scarring alopecia has rarely been described in this disease. Here, we present a 69-year-old woman who developed an erythrodermic episode of PRP associated with telogen effluvium that left an area of persistent alopecia of the scalp and resulted in hair loss in the eyebrows. The biopsy of that area of the scalp demonstrated a scarring alopecia with lichen-planopilaris-like features. Despite this histopathology, the alopecia responded well to treatment. This finding expands the context in which lichen planopilaris features can be found and demonstrates their good prognosis under early treatment.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain.,Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
| | - Angela Hermosa-Gelbard
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Dermatology Department, Hospital Universitario Quirón San José, Madrid, Spain.,Dermatology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Raquel Novo-Lens
- Dermatology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
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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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Vázquez-Herrera NE, Sharma D, Aleid NM, Tosti A. Scalp Itch: A Systematic Review. Skin Appendage Disord 2018; 4:187-199. [PMID: 30197900 PMCID: PMC6120392 DOI: 10.1159/000484354] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 12/19/2022] Open
Abstract
Scalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients.
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Affiliation(s)
| | - Divya Sharma
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nouf Mohammed Aleid
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, FL, USA
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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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