Extensive extraspinal hyperostoses after long-term oral retinoid treatment in a patient with pityriasis rubra pilaris.
We describe a patient with severe pityriasis rubra pilaris in whom extensive extraspinal hyperostoses developed after 13 years of oral retinoid treatment. The most prominent abnormality was a bridging exostosis between the left acetabulum and collum. X-ray examinations of the spine during retinoid therapy showed no abnormalities. During oral retinoid treatment, it is important to ask the patient on a regular basis about any skeletal pains or mobility restriction. Normal spinal x-ray results are no guarantee that a patient is free of hyperostoses. Discontinuation of acitretin therapy resulted in a severe exacerbation of the patient's pityriasis rubra pilaris after 2 weeks. The clinical response to administration of azathioprine was clearly inferior to that of acitretin. However, low-dose oral methotrexate therapy appeared to be a good alternative in this patient, with a clinical result comparable to acitretin and no side effects after 6 months of therapy.
van Dooren-Greebe
R J
RJ
Department of Dermatology, University Hospital Nijmegen, The Netherlands.
van de Kerkhof
P C
PC
D000077:Acetabulum / Q000187:drug effects*; D017255:Acitretin / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D005050:Etretinate / Q000009:adverse effects; D005096:Exostoses / Q000139:chemically induced*; D005272:Femur Neck / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D015576:Hyperostosis / Q000139:chemically induced*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010916:Pityriasis Rubra Pilaris / Q000188:drug therapy*; D012176:Retinoids / Q000008:administration & dosage / Q000009:adverse effects*; D014212:Tretinoin / Q000009:adverse effects
D012176:Retinoids; D014212:Tretinoin; D005050:Etretinate; D017255:Acitretin; D001379:Azathioprine; D008727:Methotrexate