title: Drug-related pityriasis rubra pilaris with acantholysis.
abstract: BACKGROUND
  Acantholysis is rarely reported histological feature of Pityriasis rubra pilaris (PRP), recently recognized as having diagnostic specificity for differentiating PRP from psoriasis.
  
  
  METHODS
  Adult male patient one week after the introduction of simvastatin had experienced pruritic erythemo-squamous eruption on head and upper trunk that in a month progressed to erythrodermia, with islands of sparing. Histological picture combined pemphigus-like acantholysis with alternating hyper- and parakeratosis, follicular plugs and dermal inflammation, and confirmed the clinical diagnosis of classic adult type 1 PRP. Acitretin therapy resulted in a resolution of skin disease. Patch test with simvastatin was negative, scratch test was positive, and it was estimated that potential risk of oral challenge with simvastatin outweighed actual need for it. Drug triggering PRP episode is the most likely explanation for temporal relation between the start of simvastatin treatment and skin eruption.
  
  
  CONCLUSIONS
  In management of rare inflammatory skin disease, such as PRP, we have to carefully observe and evaluate not only diagnostic features but possible external influences on its course also.
authors.affiliation: Dermatovenereological Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia. gajinovz@uns.ac.rs
authors.forename: Zorica T
authors.initials: ZT
authors.lastname: Gajinov
authors.forename: Milan B
authors.initials: MB
authors.lastname: Matić
authors.forename: Verica D
authors.initials: VD
authors.lastname: Duran
authors.forename: Nada
authors.initials: N
authors.lastname: Vucković
authors.forename: Sonja T
authors.initials: ST
authors.lastname: Prcić
authors.forename: Ljuba M
authors.initials: LM
authors.lastname: Vujanović
mesh_terms: D000051:Acantholysis / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D017255:Acitretin / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006257:Head / Q000473:pathology; D006801:Humans; D007641:Keratolytic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010916:Pityriasis Rubra Pilaris / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D019821:Simvastatin / Q000008:administration & dosage / Q000009:adverse effects*; D013909:Thorax / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D007641:Keratolytic Agents; D019821:Simvastatin; D017255:Acitretin