1
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Moledina M, Davison S, Malik A. Ophthalmic complication of pityriasis rubra pilaris. BMJ Case Rep 2024; 17:e256445. [PMID: 38806396 DOI: 10.1136/bcr-2023-256445] [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: 05/30/2024] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare dermatological condition which may present with ocular manifestations. We report a case of recurrent cicatricial ectropion (CE) with topical beta-blocker use in the rare dermatological condition PRP. The patient underwent release of scar tissue, lateral tarsal strip and full-thickness supraclavicular skin graft for CE following immunosuppression with methotrexate for 3 months. Postoperatively, CE recurred, with skin graft shrinkage and resumption of periocular disease activity, 8 weeks following the introduction of topical timolol. The patient was referred for further immunosuppression and substitution of timolol before consideration for further surgery. PRP has a variety of potential ocular complications. Surgery has a high risk of recurrence and should be performed when the overall disease is quiescent and drugs, which could trigger reactivation, have been discontinued and/or substituted. Skin grafts should be oversized to off-set shrinkage.
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Affiliation(s)
- Malik Moledina
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Simon Davison
- Barking Havering and Redbridge University Hospitals NHS Trust, Romford, London, UK
| | - Adeela Malik
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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2
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Chandy RJ, Chokshi A, Tan I, Feldman SR. Biologics for Treatment of Pityriasis Rubra Pilaris: A Literature Review. J Cutan Med Surg 2024; 28:269-275. [PMID: 38549359 DOI: 10.1177/12034754241238735] [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: 05/31/2024]
Abstract
OBJECTIVE To describe the published efficacy and adverse event rates associated with existing biologics for the treatment of pityriasis rubra pilaris (PRP). DATA SOURCES A literature review using the PubMed database (January 1990-July 2023) was conducted. Multiple search combinations were conducted using "pityriasis rubra pilaris" and various biologics as keywords to identify relevant articles. STUDY SELECTION AND DATA EXTRACTION Inclusion criteria included all study types that were published within the past 30 years in English and mentioned at least one biologic and PRP. A preliminary search yielded a total of 499 results. After screening using inclusion and exclusion criteria, 77 relevant articles (69 case reports, 5 case series, 2 clinical trials, and 1 retrospective analysis) were analyzed. DATA SYNTHESIS TNF-α inhibitors have been evaluated and are effective in treating PRP. However, recent treatment with anti-interleukin (IL)-17 and anti-IL-23 therapies such as ustekinumab, secukinumab, and ixekizumab are emerging as new treatment options with a mean improvement in PRP Area and Severity Index scores, change in severity of erythema, scaling, and thickness of PRP lesions. From initial clinical trials, secukinumab and ixekizumab are promising treatment options for achieving remission. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review compares the efficacy for numerous biologics and a discussion to guide clinicians on benefits and risks in choosing a biologic for PRP patients. CONCLUSIONS Biologics may be a favourable treatment option leading to greater patient adherence due to reduced dosing frequencies, improvement in quality of life, and reduction in frequency and severity of flares.
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Affiliation(s)
- Rithi J Chandy
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aditi Chokshi
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Isabella Tan
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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3
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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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4
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Kołt-Kamińska M, Osińska A, Kaznowska E, Reich A. Successful Treatment of Pityriasis Rubra Pilaris with Risankizumab in Children. Dermatol Ther (Heidelb) 2023; 13:2431-2441. [PMID: 37704911 PMCID: PMC10539248 DOI: 10.1007/s13555-023-01005-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease that affects men and women of all ages, including children. PRP is characterized by follicular and palmoplantar hyperkeratosis and salmon-colored scaling plaques. The exact pathogenesis of PRP is still unknown; most PRP cases are acquired, but some cases may show a familial occurrence, often associated with a mutation in the CARD14 gene. Due to the rarity of PRP, treatment recommendations are based mainly on case reports, small case series and expert opinions and still represent a major therapeutic challenge, especially in children. A growing number of reports on treatment with biologicals, particularly anti-TNFα, has been published. However, an involvement of the IL-23/Th17 axis in both psoriasis and PRP pathogenesis may suggest that this pathway may be a potential therapeutic target. Here, we present three pediatric patients with PRP successfully treated with risankizumab. All patients exhibited a severe course of PRP and lack of response to conventional therapy, including acitretin, cyclosporine and phototherapy. A single dose of 75 mg risankizumab resulted in almost complete clearance of skin lesions in case 1 and 2 at week 4. In patient 3, clear skin was achieved after the second administration of risankizumab (150 mg). All patients continue the treatment with risankizumab, and no adverse effects have been reported up to the present time. Our study demonstrates that risankizumab, an IL-23 blocker, shows good efficacy and safety among pediatric patients with PRP.
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Affiliation(s)
- Marta Kołt-Kamińska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2, 35-055, Rzeszów, Poland
| | | | - Ewa Kaznowska
- Department of Pathomorphology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Szopena 2, 35-055, Rzeszów, Poland.
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5
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Duncan P, Flood D, Dietz C. A Rare Post-infectious Rash: Pityriasis Rubra Pilaris After COVID-19 Infection. Cureus 2023; 15:e43810. [PMID: 37731438 PMCID: PMC10508871 DOI: 10.7759/cureus.43810] [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: 08/17/2023] [Indexed: 09/22/2023] Open
Abstract
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.
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Affiliation(s)
- Philicia Duncan
- Division of Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Daniel Flood
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Christina Dietz
- Division of Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
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6
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Boudreaux BW, Pincelli TP, Bhullar PK, Patel MH, Brumfiel CM, Li X, Heckman MG, Pittelkow MR, Mangold AR, Sluzevich JC. Secukinumab for the treatment of adult-onset pityriasis rubra pilaris: a single-arm clinical trial with transcriptomic analysis. Br J Dermatol 2022; 187:650-658. [PMID: 35701384 DOI: 10.1111/bjd.21708] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The pathogenesis of pityriasis rubra pilaris (PRP) is not completely understood, but interleukin (IL)-17 has been shown to play a critical role. There are no reliable immunomodulatory agents to treat PRP. We conducted an open-label, single-arm clinical trial of secukinumab, a monoclonal antibody that inhibits IL-17A, for the treatment of PRP. OBJECTIVES To evaluate the clinical efficacy of secukinumab and define the transcriptomic landscape of PRP and its response to IL-17A blockade. METHODS Twelve patients with PRP were recruited for an open-label trial of secukinumab. Patients received a 24-week course of secukinumab. The primary endpoint was a ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75) from baseline to week 28. Secondary endpoints included PASI 90, change in Physician's Global Assessment (PGA), and change in Dermatology Life Quality Index (DLQI). RNA sequencing was performed on lesional and nonlesional skin biopsies obtained at baseline and week 2. Sample groups were compared to identify differential gene expression and pathway enrichment. This trial was registered with ClinicalTrials.gov: 'Cosentyx (secukinumab) for the treatment of adult onset pityriasis rubra pilaris' - NCT03342573. RESULTS At week 28, six of 11 patients (55%) achieved PASI 75, and three patients (27%) achieved PASI 90. PGA (P = 0.008) and DLQI scores (P = 0.010) showed significant improvement with treatment. No serious treatment-related adverse events were encountered. Treatment with secukinumab normalized transcriptional differences between lesional and nonlesional skin. Transcriptomic data from nonresponsive patients suggest that overactivity of innate immune pathways may be driving resistance to secukinumab. CONCLUSIONS Secukinumab appears to be an effective treatment for PRP and warrants further investigation. PRP is a transcriptionally heterogeneous disease, reflecting its variable response to therapy. Agents targeting other IL-17 isoforms and innate immune mediators should be considered for future clinical trials. What is already known about this topic? The pathogenesis of pityriasis rubra pilaris is incompletely understood. Successful treatment has been reported with a variety of immunomodulatory agents, but disease is often refractory to therapy. Interleukin (IL)-17 is thought to drive keratinocyte proliferation and vascular dysfunction in this disease. A previous trial demonstrated efficacy of the anti-IL-17A drug ixekizumab for pityriasis rubra pilaris. What does this study add? Herein we describe the findings of a clinical trial of secukinumab, an anti-IL-17A monoclonal antibody, for the treatment of pityriasis rubra pilaris. Secukinumab was effective in treating pityriasis rubra pilaris. Our transcriptomic data give new insight into the expressional changes that occur in response to secukinumab and suggest mechanisms of treatment resistance.
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Affiliation(s)
| | | | - Puneet K Bhullar
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Meera H Patel
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | - Xing Li
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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7
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Xu YH, Dong DD, Ling YF, Wang Q, Huang LM, Shi JQ. Successful treatment of severe pityriasis rubra pilaris with secukinumab in a 3-year-old boy. Clin Exp Dermatol 2022; 47:2043-2045. [PMID: 35906074 DOI: 10.1111/ced.15353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Yong-Hui Xu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dan-Dan Dong
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yu-Feng Ling
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qian Wang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Liang-Mei Huang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jian-Qiang Shi
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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8
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Iznardo H, Puig L. Beyond plaque psoriasis - pathogenesis and treatment of other psoriasis phenotypes. Curr Opin Rheumatol 2022; 34:225-234. [PMID: 35699337 DOI: 10.1097/bor.0000000000000882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Psoriasis vulgaris is the commonest presentation of psoriatic disease, but morphologic variants such as pustular psoriasis (PP) and a closely related disease, pityriasis rubra pilaris (PRP), have been known for a long time, have been associated with rheumatologic manifestations indistinguishable from psoriatic arthritis (PsA) that may go unrecognized, and often represent a therapeutic conundrum. There is recent evidence that underlying genetic and pathogenetic differences may provide the basis for newer therapeutic approaches. RECENT FINDINGS This narrative review highlights the clinical, genetic and pathogenetic characteristics of PP and PRP, their association with PsA and recent developments in their treatment, especially with biologic agents targeting IL-36 and other cytokines of pathogenic relevance. SUMMARY The clinical manifestations of PP and PRP are less well known to rheumatologists than those of psoriasis, and recent advances in our insight on their pathogenesis may eventually overcome the therapeutic difficulties faced by dermatologists and rheumatologists in the management of these diseases and their rheumatologic manifestations.
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Affiliation(s)
- Helena Iznardo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain
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9
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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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10
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Jangid K, Vilhekar P, Tambe S. Treatment of Classic Juvenile Pityriasis Rubra Pilaris with Oral Isotretinoin. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_165_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Abstract
Vitamin and mineral supplement consumption is widespread. They are taken for a variety of conditions, including dermatologic disorders. Although consumers often assume these supplements are safe, excessive consumption of supplements may have deleterious effects. Such vitamin supplements include vitamin A, niacin, biotin, vitamin D, and vitamin E, and specific mineral supplements include zinc, copper, and iron. These supplements may have a number of potential adverse effects.
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Affiliation(s)
- Freidrich Anselmo
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marcia S Driscoll
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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12
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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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13
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Lamberg O, Cao S, Sabater-Geib S, Lowe L, Elder J. A case of recurrent and paraneoplastic pityriasis rubra pilaris. JAAD Case Rep 2021; 12:74-76. [PMID: 34041337 PMCID: PMC8141418 DOI: 10.1016/j.jdcr.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Olivia Lamberg
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Severine Cao
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Lori Lowe
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan.,Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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14
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Lima AL, Pahnke F, Schliemann S, Tittelbach J, Elsner P. Therapieresistente Pityriasis rubra pilaris erfolgreich therapiert mit Adalimumab. J Dtsch Dermatol Ges 2021; 19 Suppl 1:11-13. [PMID: 33835655 DOI: 10.1111/ddg.14472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Luiza Lima
- Klinik für Hautkrankheiten des Universitätsklinikums Jena
| | | | | | | | - Peter Elsner
- Klinik für Hautkrankheiten des Universitätsklinikums Jena
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15
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Halper K, Wright B, Maloney NJ, Kim MM, Ravi V, Worswick S, Lei DK. Characterizing Disease Features and Other Medical Diagnoses in Patients With Pityriasis Rubra Pilaris. JAMA Dermatol 2021; 156:1373-1374. [PMID: 32965475 DOI: 10.1001/jamadermatol.2020.3426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katherine Halper
- Department of Dermatology, University of Southern California, Los Angeles
| | - Benjamin Wright
- Department of Dermatology, University of Southern California, Los Angeles
| | - Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mindy M Kim
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | - Vignesh Ravi
- Department of Dermatology, University of Southern California, Los Angeles
| | - Scott Worswick
- Department of Dermatology, University of Southern California, Los Angeles
| | - Donald K Lei
- Department of Dermatology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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16
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Inoue E, Arase N, Hanaoka Y, Tanemura A, Fujimoto M. The beneficial effect of a PDE4 inhibitor in a patient with juvenile-onset intractable pityriasis rubra pilaris without CARD14 mutation. Dermatol Ther 2021; 34:e14714. [PMID: 33368948 DOI: 10.1111/dth.14714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Emi Inoue
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriko Arase
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuma Hanaoka
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsushi Tanemura
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Laboratory of Cutaneous Immunology, WPI Immunology Frontier Research Center, Osaka University, Suita, Osaka, Japan
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17
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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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18
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Gisondi P, Bellinato F, Girolomoni G. Topographic Differential Diagnosis of Chronic Plaque Psoriasis: Challenges and Tricks. J Clin Med 2020; 9:E3594. [PMID: 33171581 PMCID: PMC7695211 DOI: 10.3390/jcm9113594] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psoriasis is an inflammatory skin disease presenting with erythematous and desquamative plaques with sharply demarcated margins, usually localized on extensor surface areas. OBJECTIVE To describe the common differential diagnosis of plaque psoriasis classified according to its topography in the scalp, trunk, extremities, folds (i.e., inverse), genital, palmoplantar, nail, and erythrodermic psoriasis. METHODS A narrative review based on an electronic database was performed including reviews and original articles published until 1 September 2020, assessing the clinical presentations and differential diagnosis for psoriasis. RESULTS Several differential diagnoses could be considered with other inflammatory, infectious, and/or neoplastic disorders. Topographical differential diagnosis may include seborrheic dermatitis, tinea capitis, lichen planopilaris in the scalp; lupus erythematosus, dermatomyositis, cutaneous T-cell lymphomas, atopic dermatitis, syphilis, tinea corporis, pityriasis rubra pilaris in the trunk and arms; infectious intertrigo in the inguinal and intergluteal folds and eczema and palmoplantar keratoderma in the palms and soles. CONCLUSIONS Diagnosis of psoriasis is usually straightforward but may at times be difficult and challenging. Skin cultures for dermatophytes and/or skin biopsy for histological examination could be required for diagnostic confirmation of plaque psoriasis.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy; (F.B.); (G.G.)
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19
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Williams A, George A, Thomas EA, Koshy JM. Pityriasis rubra pilaris type 6: A case report in an AIDS patient. Indian J Sex Transm Dis AIDS 2020; 41:100-101. [PMID: 33062992 PMCID: PMC7529171 DOI: 10.4103/ijstd.ijstd_120_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/27/2016] [Accepted: 12/22/2019] [Indexed: 12/03/2022] Open
Abstract
A 24-year-old woman, known to be human immunodeficiency virus positive for 6 years, presented with an itchy rash on the body. She had dull erythematous to hyperpigmented scaly plaques over the body, with extensor predominance. Inflammatory papules and nodules were noted on the face. Follicular hyperkeratotic papules were seen on the shins, giving a “nutmeg grater” feel. All her nails were dystrophic. Histopathology was consistent with the clinical diagnosis of pityriasis rubra pilaris. CD4 counts had dropped to 192 cells/μl, so she was started on antiretroviral therapy along with acitretin to which she responded well within 2 months.
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Affiliation(s)
- Abhilasha Williams
- Department of Dermatology, Christian Medical College, Ludhiana, Punjab, India
| | - Anisha George
- Department of Dermatology, Christian Medical College, Ludhiana, Punjab, India
| | - Emy Abi Thomas
- Department of Dermatology, Christian Medical College, Ludhiana, Punjab, India
| | - Jency Maria Koshy
- Department of Medicine, Christian Medical College, Ludhiana, Punjab, India
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20
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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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21
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Mellett M. Regulation and dysregulation of CARD14 signalling and its physiological consequences in inflammatory skin disease. Cell Immunol 2020; 354:104147. [DOI: 10.1016/j.cellimm.2020.104147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
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22
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Sander M, Sander M. Acral pityriasis rubra pilaris. CMAJ 2020; 192:E118. [PMID: 32015081 DOI: 10.1503/cmaj.190961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael Sander
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Megan Sander
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.
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23
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Heinrich M, Cook E, Roach J, Juarez RM, Payne D, Atkins R, Stetson C. Erythrodermic psoriasis secondary to systemic corticosteroids. Proc AMIA Symp 2020; 33:113-114. [PMID: 32063793 DOI: 10.1080/08998280.2019.1686911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 01/31/2023] Open
Abstract
Erythroderma is an uncommon, potentially life-threatening condition, which has many causes, including uncontrolled psoriasis. We present a 58-year-old woman with psoriasis who, after an abrupt discontinuation of systemic corticosteroids, developed erythrodermic psoriasis with extensive body surface involvement requiring hospital admission. Erythrodermic psoriasis requires a high index of suspicion to diagnose it in a timely fashion and treat it to prevent complications.
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Affiliation(s)
- Matthew Heinrich
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Elizabeth Cook
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Jenna Roach
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Rita Medrano Juarez
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Drew Payne
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Randy Atkins
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
| | - Cloyce Stetson
- Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas
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24
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Wang JY, Tabata MM, Pugliese S, Phillips D, Kim J, Weng W, Kwong BY. Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients. Clin Case Rep 2019; 7:2491-2494. [PMID: 31893086 PMCID: PMC6935619 DOI: 10.1002/ccr3.2458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 11/09/2022] Open
Abstract
Chronic cutaneous graft-vs-host disease (GVHD) has several atypical variants. We describe two cases of GVHD with clinical and histopathologic features of pityriasis rubra pilaris (PRP), which responded to additional immunosuppression. Recognition of this newly described PRP-like clinical presentation of GVHD may prompt early consideration of additional steroid-sparing therapies.
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Affiliation(s)
- Jennifer Y. Wang
- Department of DermatologyStanford University Medical CenterStanfordCalifornia
| | - Mika M. Tabata
- Department of DermatologyStanford University Medical CenterStanfordCalifornia
| | - Silvina Pugliese
- Department of DermatologyStanford University Medical CenterStanfordCalifornia
| | - Darci Phillips
- Department of DermatologyStanford University Medical CenterStanfordCalifornia
| | - Jinah Kim
- Department of DermatologyStanford University Medical CenterStanfordCalifornia
- Department of PathologyStanford University Medical CenterStanfordCalifornia
- Department of DermatopathologyPalo Alto Medical FoundationPalo AltoCalifornia
| | - Wen‐Kai Weng
- Division of Blood and Marrow TransplantationDepartment of MedicineStanford University Medical CenterStanfordCalifornia
| | - Bernice Y. Kwong
- Department of DermatologyStanford University Medical CenterStanfordCalifornia
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25
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Leite OG, Tagliolatto S, Souza EMD, Cintra ML. Acantholytic pityriasis rubra pilaris associated with topical use of imiquimod 5%: case report and literature review. An Bras Dermatol 2019; 95:63-66. [PMID: 31789270 PMCID: PMC7058836 DOI: 10.1016/j.abd.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022] Open
Abstract
Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.
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Affiliation(s)
| | - Sandra Tagliolatto
- Dermoclínica, Campinas, SP, Brazil; Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Elemir Macedo de Souza
- Discipline of Dermatology, Department of Clinical Medicine, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Letícia Cintra
- Department of Anatomical Pathology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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26
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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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27
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Cole D, Mohammad T, Lim H. Rapid response of pityriasis rubra pilaris with psoriasis overlap to secukinumab. Br J Dermatol 2019; 181:1331-1332. [DOI: 10.1111/bjd.18263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D. Cole
- Wayne State University School of Medicine Detroit Michigan U.S.A
| | - T. Mohammad
- Department of Dermatology Henry Ford Hospital Detroit Michigan U.S.A
| | - H. Lim
- Department of Dermatology Henry Ford Hospital Detroit Michigan U.S.A
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28
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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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29
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Brown-Joel ZO, Chung J, Stone MS. Pityriasis rubra pilaris-like eruption in the setting of transient acantholytic dermatosis. JAAD Case Rep 2019; 5:733-735. [PMID: 31440571 PMCID: PMC6698694 DOI: 10.1016/j.jdcr.2019.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Jina Chung
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Dermatology, Iowa City VA Medical Center, Iowa City, Iowa
| | - Mary S Stone
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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30
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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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31
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Gál B, Göblös A, Danis J, Farkas K, Sulák A, Varga E, Nagy N, Széll M, Kemény L, Bata-Csörgő Z. The management and genetic background of pityriasis rubra pilaris: a single-centre experience. J Eur Acad Dermatol Venereol 2019; 33:944-949. [PMID: 30697821 DOI: 10.1111/jdv.15455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory dermatosis with multifactorial aetiology. It is known that particular caspase recruitment domain family member 14 (CARD14) gene mutations are associated with familial PRP and certain forms of psoriasis. Additionally, few data are available about the role of CARD14 gene variants in sporadic PRP. The clinical picture is variable for the different types of PRP, therefore choosing the adequate treatment is often difficult, furthermore there are no specific guidelines for therapy. OBJECTIVE Our aim was to survey the efficacy of the applied therapies and to screen the CARD14 gene variants in our PRP patients. METHODS In this retrospective study, patients diagnosed with PRP between 2006 and 2016 at our clinic were involved. Besides the follow-up study of the treatments, the genetic analysis of CARD14 gene was performed. RESULTS We analysed 19 patients, among whom 17 were diagnosed with type I, one with type III, and one with type V PRP. The majority of the patients were successfully treated with acitretin in combination with systemic corticosteroids, and the remaining patients were treated with other systemic therapies with diverse effects. The genetic screening of CARD14 gene revealed two previously described mutations (rs114688446, rs117918077) and six polymorphisms (rs28674001, rs2066964, rs34367357, rs11653893, rs11652075, rs2289541). Ten of 19 patients carried different CARD14 genetic variants either alone or in combination. CONCLUSION Based on our experience, we propose that acitretin and an initial combination of short-term systemic corticosteroid therapy could be a successful treatment option for PRP. Although we identified several CARD14 variants in almost half of our cases, we did not find a correlation between the therapeutic response and the genetic background. Our data support the previous observation that CARD14 genetic variants are not specific to PRP, although they may indicate chronic inflammation.
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Affiliation(s)
- B Gál
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - A Göblös
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, Szeged, Hungary
| | - J Danis
- MTA-SZTE Dermatological Research Group, Szeged, Hungary
| | - K Farkas
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - A Sulák
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - E Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - N Nagy
- MTA-SZTE Dermatological Research Group, Szeged, Hungary.,Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - M Széll
- MTA-SZTE Dermatological Research Group, Szeged, Hungary.,Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - L Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, Szeged, Hungary
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, Szeged, Hungary
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32
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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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33
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Atzori L, Zanniello R, Lappi A, Pinna AL, Ferreli C, Rongioletti F, Pilloni L. Successful treatment of erythrodermic pityriasis rubra pilaris with acitretin. Dermatol Ther 2018; 31:e12694. [PMID: 30230135 DOI: 10.1111/dth.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/21/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Atzori
- Dermatology Clinic, AOU of Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Ramona Zanniello
- Dermatology Clinic, AOU of Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Astrid Lappi
- Dermatology Clinic, AOU of Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Anna Luisa Pinna
- Dermatology Clinic, AOU of Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Dermatology Clinic, AOU of Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, AOU of Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Pilloni
- Anatomopathology, Department of Surgical Science, University of Cagliari, Cagliari, Italy
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34
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Affiliation(s)
| | - Haley D Heibel
- Creighton University School of Medicine, Omaha, Nebraska
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35
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Abstract
Erythroderma, often described as generalized exfoliative dermatitis, is a condition in which erythema involves greater than 90% of the body surface, often as a result of an underlying inflammatory skin condition, which can result in a variety of systemic manifestations and potentially lead to life-threatening complications.
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Affiliation(s)
- Emily Rose
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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36
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Genovese G, Muratori S, Berti E, Marzano AV. Bullous erythroderma: novel association of pityriasis rubra pilaris with bullous pemphigoid. Clin Exp Dermatol 2018; 44:73-75. [PMID: 30129048 DOI: 10.1111/ced.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- G Genovese
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - S Muratori
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - E Berti
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
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Danis J, Göblös A, Gál B, Sulák A, Farkas K, Török D, Varga E, Korom I, Kemény L, Széll M, Bata-Csörgö Z, Nagy N. Nuclear Factor κB Activation in a Type V Pityriasis Rubra Pilaris Patient Harboring Multiple CARD14 Variants. Front Immunol 2018; 9:1564. [PMID: 30018619 PMCID: PMC6037727 DOI: 10.3389/fimmu.2018.01564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare papulosquamous skin disorder, which is phenotypically related to psoriasis. Some familial PRP cases show autosomal dominant inheritance due to CARD14 mutations leading to increased nuclear factor κB (NFκB) activation. Moreover, CARD14 polymorphisms have also been implicated in sporadic PRP. A Hungarian PRP patient with childhood onset disease showing worsening of the symptoms in adulthood with poor therapeutic response underwent genetic screening for the CARD14 gene, revealing four genetic variants (rs117918077, rs2066964, rs28674001, and rs11652075). To confirm that the identified genetic variants would result in altered NFκB activity in the patient, functional studies were carried out. Immunofluorescent staining of the NFκB p65 subunit and NFκB-luciferase reporter assay demonstrated significantly increased NFκB activity in skin samples and keratinocytes from the PRP patient compared to healthy samples. Characterization of the cytokine profile of the keratinocytes and peripheral blood mononuclear cells demonstrated that the higher NFκB activation in PRP cells induces enhanced responses to inflammatory stimuli. These higher inflammatory reactions could not be explained solely by the observed CARD14 or other inflammation-related gene variants (determined by whole exome sequencing). Thus our study indicates the importance of investigations on other genetic factors related to PRP and their further functional characterization to bring us closer to the understanding of cellular and molecular background of disease pathogenesis.
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Affiliation(s)
- Judit Danis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Anikó Göblös
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Brigitta Gál
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Adrienn Sulák
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Katalin Farkas
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Dóra Török
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Erika Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Irma Korom
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Márta Széll
- MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.,Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Bata-Csörgö
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary
| | - Nikoletta Nagy
- MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.,Department of Medical Genetics, University of Szeged, Szeged, Hungary
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38
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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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Dewan AK, Sowerby L, Jadeja S, Lian C, Wen P, Brown JR, Fisher DC, LeBoeuf NR. Pityriasis rubra pilaris-like erythroderma secondary to phosphoinositide 3-kinase inhibition. Clin Exp Dermatol 2018; 43:890-894. [PMID: 29851132 DOI: 10.1111/ced.13608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Phosphoinositide 3-kinase (PI3K) inhibitors are a class of small-molecule inhibitors approved for the treatment of certain leukaemias and lymphomas. Their dermatological adverse event profile is poorly described. AIM To characterize a rare cutaneous adverse event from PI3K inhibitors in order to help dermatologists and oncologists identify and effectively manage such eruptions. METHODS This was a retrospective analysis of patients receiving PI3K inhibitors referred to the Skin Toxicities Program in The Center for Cutaneous Oncology. RESULTS Three patients on PI3K inhibitors for treatment of malignancy developed diffuse erythroderma and keratoderma. Clinical and histopathological findings were consistent with pityriasis rubra pilaris (PRP)-like reactions. All patients improved with topical and oral corticosteroids, oral acitretin, and drug discontinuation. CONCLUSIONS PRP-like cutaneous eruptions may develop secondary to PI3K inhibition. Early dermatological evaluation of cutaneous toxicities to PI3K inhibitors as well as rapid initiation of disease-specific treatments may help keep patients on life-prolonging anti-cancer therapies.
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Affiliation(s)
- A K Dewan
- Department of Dermatology, The Center for Cutaneous Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - L Sowerby
- Department of Dermatology, The Center for Cutaneous Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - S Jadeja
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - C Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - P Wen
- Department of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J R Brown
- Chronic Lymphocytic Leukemia Center and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - D C Fisher
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - N R LeBoeuf
- Department of Dermatology, The Center for Cutaneous Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
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40
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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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41
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Queirós N, Torres T. HIV-associated psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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42
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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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43
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Song H, Margossian SP, Huang JT. Diffuse pityriasiform eruption in a pediatric patient after bone marrow transplantation. Pediatr Dermatol 2018; 35:246-247. [PMID: 29575069 DOI: 10.1111/pde.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hannah Song
- Harvard Medical School, Boston, MA, USA.,Dermatology Program, Boston Children's Hospital, Boston, MA, USA
| | - Steven P Margossian
- Department of Pediatric Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jennifer T Huang
- Dermatology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, USA
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44
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Gironi LC, Tiberio R, Dagna L, Landucci G, Giacalone A, Boldorini RL, Colombo E, Savoia P. Rapid response to cyclosporine in a rare case of pityriasis rubra pilaris with autoantibodies and systemic symptoms. GIORN ITAL DERMAT V 2018; 154:728-730. [PMID: 29417801 DOI: 10.23736/s0392-0488.18.05906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Laura C Gironi
- Department of Health Sciences, A. Avogadro University of Eastern Piedmont, Novara, Italy -
| | - Rossana Tiberio
- Department of Health Sciences, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluca Landucci
- Department of Health Sciences, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Angela Giacalone
- Section of Pathology, Department of Health Sciences, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Renzo L Boldorini
- Section of Pathology, Department of Health Sciences, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Enrico Colombo
- Department of Translational Medicine, A. Avogadro University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Department of Health Sciences, A. Avogadro University of Eastern Piedmont, Novara, Italy
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45
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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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46
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Queirós N, Torres T. HIV-Associated Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:303-311. [PMID: 29361272 DOI: 10.1016/j.ad.2017.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023] Open
Abstract
Human immunodeficiency virus (HIV) prevalence is increasing worldwide as people on antiretroviral therapy are living longer. These patients are often susceptible to debilitating inflammatory disorders that are frequently refractory to standard treatment. Psoriasis is a systemic inflammatory disorder, associated with both physical and psychological burden, and can be the presenting feature of HIV infection. In this population, psoriasis tends to be more severe, to have atypical presentations and higher failure rates with the usual prescribed treatments. Management of moderate and severe HIV-associated psoriasis is challenging. Systemic conventional and biologic agents may be considered, but patients should be carefully followed up for potential adverse events, like opportunist infections, and regular monitoring of CD4 counts and HIV viral loads.
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Affiliation(s)
- N Queirós
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - T Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal; Unidad de Dermatología, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
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47
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Roenneberg S, Biedermann T. Pityriasis rubra pilaris: algorithms for diagnosis and treatment. J Eur Acad Dermatol Venereol 2018; 32:889-898. [DOI: 10.1111/jdv.14761] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/30/2017] [Indexed: 12/11/2022]
Affiliation(s)
- S. Roenneberg
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Germany Munich
| | - T. Biedermann
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Germany Munich
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48
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Abstract
Pityriasis rubra pilaris is a rare heterogeneous dermatosis associating three clinical signs to different degrees: follicular corneal papules, reddish-orange palmoplantar keratoderma and erythematosquamous lesions that may in some cases be very extensive, interspersed with patches of healthy skin. The aetiology is unclear, and in most cases, the trigger factors consist of trauma or infection, probably in subjects with an existing predisposition. In other cases, the condition is associated with immunological disorders or, in familial cases, genetic keratinisation abnormalities similar to ichthyosis. Given the widely varying signs, several classifications have been proposed, based on clinical criteria and outcomes. The outcome varies in accordance with the clinical forms involved. Therapeutic approaches are poorly qualified and there have been no clinical trials due to the rarity of the disease. However, the best results appear to have been obtained using oral retinoids, with second-line therapy comprising methotrexate and cyclosporine. The landscape of therapeutic strategy seems to be changing with the advent of new anti-tumour necrosis factor and anti-interleukin-12/23 antibodies.
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49
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Abstract
An 8-year-old boy who was initially diagnosed with plaque psoriasis failed management with topical therapies and skin biopsy confirmed the suspected diagnosis of juvenile pityriasis rubra pilaris (PRP). Pityriasis rubra pilaris is a rare inflammatory disorder of the skin characterized by follicular keratotic papules coalescing into plaques, along with palmoplantar keratoderma. Treatment modalities include topical and systemic therapies, although previous studies have not shown much benefit with methotrexate in children. We present a case in which methotrexate led to significant improvement of the skin findings in a child with type IV juvenile pityriasis rubra pilaris.
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Affiliation(s)
- Anne H Boyd
- Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ingrid C Polcari
- Department of Pediatric Dermatology, University of Minnesota, Minneapolis, MN, USA
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50
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Chen SX, Hinds BR, Goodman AM, Cohen PR. Erythrodermic Psoriasis in a Man with Monoclonal B-cell Lymphocytosis. Cureus 2017; 9:e1936. [PMID: 29464143 PMCID: PMC5807020 DOI: 10.7759/cureus.1936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Erythroderma is characterized by erythema involving greater than 90% of the body surface area and may be caused by several etiologies, including erythrodermic psoriasis. Psoriasis is an autoimmune skin and systemic condition characterized by erythematous and scaly plaques. Monoclonal B-cell lymphocytosis is an asymptomatic hematological disorder diagnosed by elevated, small, clonal B-cell counts in the peripheral blood. The characteristics of a 71-year-old man with new onset of erythrodermic psoriasis and concurrent monoclonal B-cell lymphocytosis are presented. The simultaneous development of these two conditions raises the possibility that they may share a related pathogenesis.
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Affiliation(s)
- Stella X Chen
- School of Medicine, University of California, San Diego
| | - Brian R Hinds
- Department of Dermatology, University of California, San Diego
| | - Aaron M Goodman
- Division of Hematology and Oncology, Division of Blood and Marrow Transplantation, University of California, San Diego
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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