Pityriasis rubra pilaris--a retrospective single center analysis over eight years.
BACKGROUND
Pityriasis rubra pilaris (PRP) is a rare papulosquamous dermatosis. We evaluated evaluate co-morbidities, complications, and outcome of treatment regimens.


METHODS
This is a retrospective study at an academic teaching hospital. We analyzed all patients with the definite diagnosis of PRP seen since 2001. Epidemiologic data, co-morbidities, response to and course during treatment were investigated.


RESULTS
We identified 10 PRP-patients (6 men, 4 women), mean age 56.4 years, with type I (n = 9) and type IV (n = 1). Three patients had internal co-morbidities (atrial fibrillation with cardiac insufficiency, dilated cardiomyopathy, diabetes mellitus). Two patients needed psychiatric treatment because of depression. PRP caused ectropium (2 x), diffuse effluvium (1 x), and stenosis of the outer ear canal (1 x). We did not observe a spontaneous remission. Among 9 patients with PRP type I, five were treated with acitretin (two of them as Re-PUVA), and two with methotrexate (in one patient combined with fumaric acids). Systemic corticosteroids were not effective. One patient was treated with infliximab i.v., 5 mg/kg body weight. Starting with the first application, inflammatory activity decreased and erythema got paler. The treatment was well tolerated.


CONCLUSIONS
PRP type I is a severe, chronic inflammatory dermatosis responding hesitantly to classic systemic therapies. Tumor necrosis factor-alpha antagonists are an effective treatment option for difficult cases.
Gemmeke
Astrid
A
Department of Dermatology and Allergology, Dresden-Friedrichstadt Hospital, Dresden, Germany.
Schönlebe
Jaqueline
J
Koch
André
A
Wollina
Uwe
U
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010916:Pityriasis Rubra Pilaris / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome