Successful treatment of type I adult-onset pityriasis rubra pilaris with infliximab.
A 59-year-old woman presented with a painful, pruritic eruption that had commenced as an erythematous, dry patch on the upper back but progressed to erythroderma. Examination revealed orange-tinged erythroderma, scalp scaling, ectropion, palmoplantar keratoderma and nail changes. A diagnosis of type I adult-onset pityriasis rubra pilaris was made, and a subsequent skin biopsy was consistent with this. She was treated with a number of topical and systemic agents with minimal improvement or major side-effects. The patient was then treated with intravenous infliximab 5 mg/kg. She improved dramatically within 2 weeks and was no longer erythrodermic. Five further infusions resulted in additional improvement. Methotrexate was briefly added to the regime, but was ceased owing to nausea. Topical tar and keratolytics were used on the scalp. The patient was left with minimal disease activity and was maintained on emollients.
Manoharan
Shobhan
S
Department of Dermatology, Wirral Hospital NHS Trust, Clatterbridge Hospital, Bebington Wirral, England, UK. shobhanm@yahoo.co.uk
White
Stephen
S
Gumparthy
Krishna
K
D000005:Abdomen; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D005260:Female; D006225:Hand; D006801:Humans; D000069285:Infliximab; D008875:Middle Aged; D010916:Pityriasis Rubra Pilaris / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013909:Thorax; D014409:Tumor Necrosis Factor-alpha
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab