Pityriasis rubra pilaris (PRP) is a rare and challenging dermatological condition that often mimics other skin disorders, complicating diagnosis and management. This case is unique due to the patient’s comorbidities, which restricted treatment options and required a shift from conventional therapy to biologic treatment.

A 57-year-old male presented with a three-week history of an itchy rash on the face, neck, and upper extremities after sun exposure. Initial treatment with topical corticosteroids was ineffective, and the condition progressed to involve the trunk and lower extremities with erythroderma. Additional findings included hyperkeratosis of the palms and soles, psoriatic plaques on the elbows, and thickened toenails with onychomycosis. Histopathology revealed superficial psoriasiform dermatitis, consistent with PRP. Methotrexate (12.5 mg/week) was initiated, leading to initial improvement. However, a relapse occurred after five months, and due to elevated liver enzymes, a dose increase was not feasible. Secukinumab, an IL-17A inhibitor, was subsequently recommended by the clinic consilium. Already after one month, significant improvement was observed, and near-complete remission was achieved by four months. The patient continues treatment with secukinumab with a satisfactory clinical response and minimal residual symptoms.

This case underscores the complexities of diagnosing and managing PRP, particularly when comorbidities limit standard treatment options. The successful use of secukinumab, despite the failure of conventional therapy, demonstrates the potential of biologics in managing PRP, especially in refractory cases. It highlights the importance of personalized treatment strategies in optimizing outcomes for patients with complex dermatological conditions.

No abstract available.
Pityriasis Rubra Pilaris ; Pityriasis ; Ustekinumab

No abstract available.
Humans ; Keratoderma, Palmoplantar ; Pityriasis Rubra Pilaris ; Pityriasis ; Siblings

No abstract available.
Acrodermatitis* ; Adult* ; Humans ; Pityriasis Rubra Pilaris* ; Pityriasis* ; Zinc*

No abstract available.
Cyclosporine* ; Pityriasis Rubra Pilaris* ; Pityriasis*

Tinea versicolor (TV) is a common fungal skin disease caused by the Malassezia species. This disease usually presents as hypopigmented- or hyperpigmented coalescing scaly macules, papules, patches or plaques on the trunk and upper arms. Herein, we report a rare clinical manifestation of TV in a 29-year-old man presenting with marked follicular, erythematous, and hyperkeratotic papules on the trunk with erythematous scaly macules and patches on the upper extremities with intermittently spared skin. We initially suspected pityriasis rubra pilaris, however, skin biopsy results and mycological examination revealed TV. Polymerase chain reaction-based sequence analysis revealed Malassezia globosa. The patient was successfully treated with oral itraconazole and topical terbinafine.
Adult ; Arm ; Biopsy ; Dermatomycoses ; Humans ; Itraconazole ; Malassezia* ; Pityriasis Rubra Pilaris* ; Pityriasis* ; Sequence Analysis ; Skin ; Tinea Versicolor* ; Tinea* ; Upper Extremity

No abstract available.
Pityriasis Rubra Pilaris* ; Pityriasis*

Adult ; Epstein-Barr Virus Infections ; diagnosis ; Humans ; Male ; Pityriasis Rubra Pilaris ; diagnosis

Pityriasis amiantacea is a disease of scalp that presents with asbestos-like thick scales attached to the hair shaft proximal portion. It is considered to reaction of scalp to many inflammatory processes, such as psoriasis, seborrheic dermatitis, tinea capitis, atopic dermatitis, lichen planus, bacterial infection, and pityriasis rubra pilaris. The control of underlying disease is important to treat pitryriasis amiantacea, and there are no guidelines. Here, we report a case of a 17-year-old female who had no improvement for the general seborrheic dermatitis treatments, but displayed remarkable results after isotretinoin.
Adolescent ; Bacterial Infections ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; Female ; Hair ; Humans ; Isotretinoin ; Lichen Planus ; Pityriasis ; Pityriasis Rubra Pilaris ; Psoriasis ; Scalp ; Tinea Capitis ; Weights and Measures

Pityriasis rubra pilaris (PRP) is a chronic papulosquamous disorder of unknown etiology, which may pose therapeutic challenges. There is currently no universally effective treatment for PRP, and some cases are resistant to multiple topical and systemic therapies. Systemic retinoids, methotrexate, several immunosuppressive agents and phototherapy have all been used with varying degrees of success. Recently, a few reports have appeared in the literature, concerning the use of biologics in combination therapies and/or in refractory PRP cases. We report a case of PRP similar to type II with juvenile onset, which was recalcitrant to traditional topical and systemic therapy. He was successfully treated with anti-TNF-alpha monoclonal antibody, infliximab. The patient showed resolution with minimal disease activity, and was maintained on acitretin and emollients. The response to infliximab in our patient and in the previously reported cases confirms a role of anti-TNF-alpha therapy as an effective option in the treatment of PRP.
Acitretin ; Antibodies, Monoclonal ; Biological Agents ; Emollients ; Humans ; Immunosuppressive Agents ; Methotrexate ; Phototherapy ; Pityriasis ; Pityriasis Rubra Pilaris ; Retinoids ; Skin Diseases, Papulosquamous ; Infliximab