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.

: Pityriasis lichenoides (PL) is an inflammatory papulosquamous condition that exists in a continuous spectrum that consists mainly of pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica (PLC). The condition has been reported to erupt in response to infections, radiocontrast media, medications and vaccines. Most case reports on vaccine-related eruption involve the acute PL, hence, this report aimed to present a case presenting with lesions of the chronic variant. : A 21-year-old female presented with multiple erythematous to hyperpigmented ill defined plaques, some ulceronecrotic, topped with fine scales and excoriations on the upper and lower extremities, periumbilical area and back of 4 months duration, following rabies vaccinations. : Histopathologic findings, including interface dermatitis, parakeratosis, spongiosis, and mixed inflammatory infiltrates, confirmed the diagnosis of PLC. The patient responded well to oral corticosteroids and heliotherapy. PL is rare and requires additional research. The potential role of vaccination as an etiologic agent represented a crucial area of this investigation. Additionally, heliotherapy should be considered as a viable therapeutic alternative when phototherapy is not feasible.. Further research is needed to elucidate the pathogenesis of PL and establish evidence-based treatment protocols.
Pityriasis lichenoides chronica ; Pityriasis lichenoides ; heliotherapy ; vaccine

No abstract available.
Pityriasis Rubra Pilaris ; Pityriasis ; Ustekinumab

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

Background: Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis Versicolor.

Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis Versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, time-to-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess the risk of bias, pool studies, and calculate for treatment effects.

Results: We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient.

Conclusions: Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.

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

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

Adult ; Humans ; Male ; Pityriasis Lichenoides ; diagnosis ; drug therapy ; immunology ; Prednisolone ; administration & dosage ; therapeutic use ; Psoriasis ; diagnosis ; drug therapy ; immunology ; Young Adult