DOCSLIB.ORG

Erythroderma Due to Pityriasis Rubra Pilaris

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Erythroderma Due to Pityriasis Rubra Pilaris International Journal of Pathology; 2005; 3(2): 91-93 Case Report Erythroderma Due to Pityriasis Rubra Pilaris Ikramullah Khan and Uzma Khalil Department of Dermatology, Pakistan Institute of Medical Sciences, Islamabad Erythroderma can be due to a number of causes. Pityriasis Rubra Pilaris contributing to 1% of all the cases. Pityriasis Rubra Pilaris belongs to a rare erythematosquamous disorders of unknown etiology. We report here a case of Pityriasis Rubra Pilaris that progressed to erythroderma. Key words: pityriasis rubra pilaaris, PRP, HIV human immunodeficiency virus HAART, highly active anti retroviral therapy Introduction and toe nails were shiny. Erythroderma is generalized erythema of Nails were thickened and yellowish in colour skin affecting over 90% of body surface area. It with splinter hemorrhages and whitish longitudinal can be due to several causes. Pityriasis rubra pilaris bands. There was also subungual hyperkeratosis.. contributes to one percent of all cases of erythroderma. Palms and soles were hyperkeratotic named as PRP Pityriasis rubra pilaris is a heterogenous group of sandals. Usually PRP is associated with HIV infection disorders that have circumscribed follicular keratosis, but our patient was negative for it. brauny skin and orange red erythema. This is A skin biopsy taken from arm showed a rare disease with an incidence of one in 50001. It hyperkeratosis, parafollicular parakeratosis, follicular has a world wide distribution.15 It is one of the plugging, prominent granular layer (Figure 4 & 5). papulo squamous disorders that runs a chronic Dermis showed mild capillary dilatation and mild relapsing course.5,13 lymphohistiocytic infilterate. Some eosinophils were We report a case of pityriasis rubra also noted. pilaris which progressed into erythroderma. The A diagnosis of PRP was made and he was erythroderma subsided by the use of topical started on oral retinoids to which he responded emollients and oral retinoids. well. Our patient on follow up visits showed marked improvement. Case Report A 20 years old man presented with Discussion generalized erythema, itching and dryness of skin for Pityriasis rubra pilaris belongs to a group last 2 months. of rare erythemato squamous disorders of unknown The patient history dates back to 3 years when etiology. It is characterized by: he started having erythema, dryness and scaling of scalp and face which progressed to involve trunk and Pityriasis----prominent scaling limbs. The rash was itchy and the skin was dry. On examination there was generalized Rubra------perifollicular redness erythema of the body with an orangish tinge. There was mild bilateral pedal oedema. Cardiovascular Pilaris-----follicular plugging and respiratory systems were normal. The rest of systemic examination was unremarkable. There was It may become erythrodermic and is furaceous yellowish orange fine branny scaling on assocaiated with palmo-plantar hyper keratosis.1 whole of the body more marked on back. The finger Griffith described five subtypes and a new 91 International Journal of Pathology; 2005; 3(2): 91-93 sixth one has been described associated with HIV infection. labelling is increased from an average normal 3% to 27%. The nail growth is increased as well but not as fast as in psoriasis Type -1 Classical Adult Form The condition is Fig. 4: Skin Biopsy showing Dilated severly itchy starts from Follicular Infundibulum Filled with head spreads towards Fig. 1: Generalized Erythema with Keratin and Parakeratosisat distal parts of body.6 It Follicular Shoulders Orangish Scaling has powdery scaling and pilosebaceous follicles are plugged with keratin. They are surrounded by erythema, the over all colour is orangish yellow. The nails show longitudinal ridges , sub ungual hyperkeratosis and splinter Fig. 2: Feet of the Patient showing hemorrhages. Scaling and Erythema It may progress to erythroderma7 ,8 All Fig. 5: Skin Biopsy showing Mitosis these findings were present in our patient. Indicating Increased Epidermal There is Squamous Cell Proliferation spontaneous remission with in two to three years without recurrence.9,11 Type - II Adult Atypical Form In this form scales are coarser and more lamellated .The legs are particularly involved. Five percent of the patients belong to this type. Fig. 3: Skin showing Perifolloicular Type –III -Classical Juvenile Form; Erythema and Scaling It is not present at birth and appears at the end of first decade .One third of the patients may have family history. It may There is increased epidermal resemble adult PRP but may follow an acute infection.2 overactivity as evidenced by increased It may clear spontaneously within one to two years2. labelling indices. Epidermal thymidine 92 International Journal of Pathology; 2005; 3(2): 91-93 Type IV –Juvenile Onset Circumscribed plugging are present on elbows and knees. It may involve Type; scalp. It remains localized to knees and elbows, does not progress Circumscribed persistent further. asymptomatic plaques of follicular Type –V –Atypical Juvenile Variant can also be used. It presents early in life or even at birth. There TYPE VI PRP responds to HAART.2 is erythema, hyper keratosis follicular plugging, Photo chemotherapy may exacerbate disease palmoplantar keratoderma. It is wide spread and but narrow band UVB, PUVA bath and extra corporeal shows little tendency to clear. Some cases are familial.2 photophoresis have been found to be beneficial.2 Our case presents classical PRP clinically with TYPE - VI PRP Associated with HIV; charactristic findings on skin biopsy. Thus PRP, PRP like eruption can occur with HIV . It although rare, should be kept in the list of differential responds to HAART i.e highly active anti retro diagnosis in cases of atypical erythrodermic and viraltherapy.for HIV . psoraisiform disorders. It shows features of classical PRP with filiform keratosis of scalp face and trunk. it is also associated with acne conglobata.2 References There are no definite laboratory tests for PRP.4 Skin histopathology shows basket weave 1. VivierAD,Pityriasis rosea,pityriasis rubra pilaris.Atlas of clinicl hyperkeratosis, prominent follicular plugging, dermatology .third ed.spain elsivier,2004 91-93 2. MRjudge, W.H.I. Mclean, and C.S. Munro, Disorders of keratinization, ,acanthosis with exaggerated follicular shoulders, Rook, s text book of dermatology ,seventh edition italy Blackwell ,spotty parakeratosis and mild upper dermal science. 2004,64-66 3. Sanchez-Regana M,CreusL umbertP,pityriasi rubra pilaris a long term infiltrate. study of 25 cases,Eur j dermatol.1 1994 ;593-7 4. Weislo Dziadecka,D Krauze etal;diagnostic and therapeutic difficulties In our patient, since he was erythrodermic a in pityriasis rubra pilaris Case report PolMerkurtsz 2005; 19 (113 ): prominent scab was also noted above epidermis. 667-70. 5. Picnus D J,pityriasis rubra pilaris,a clinical review,Dermatol nurs 2005; As epidermal activity is increased so mitotic figures 17(6): 448-51. were also seen. 6. Booth A V, Ma L Pityriasis rubra pilaris type I Dermatol online J ,2005; J: 11(4) 9 The major differentials of the condition were 7. Pitman J,Muckusch.G pityriasis rubra pilaris Dermatol nurs 2005 17; psoriasis, but in an erythrodermic patient like ours (4): 302 8. Artik,S Khun A,Neumann N J, etal;pityriasis rubra pilaris ,Hautarzt other causes like eczema, drug eruption, Mycosis 2004; 55 (10): 980-3 fungoides, and Sezary syndrome must also be kept in 9. Whit K I pityriasis rubra pilaris Dermatol online J 2003; 9 (4): 6 10. Usuki K, Sekiaona T ,etal; Three cases of Pityriasis rubra pilaris mind. Successfully treated with ciclosporin A Since it is a disorder of keratinization ,it 11. Sehgal V N,Bajaj P,Jain S ,pityraisis rubra pilaris a report of four cases J Dermatol 2000; 27 (3): 174-7 responds well to oral retinoids. Like acitretin 12. Kirbey B , Watson ,R pityraisis rubra piilaris treated with Acitretin and isotertinoin12 can be used. Methotrexate is narrow band ultrvoilet B Brj Dermatol 2000; ,142 ( 8) 376-77 13. Caplan S,E Lowitt M,H ,Early presentation of pityriasis rubra pilaris, an alternative and as an adjunct to retinoids. Cutis 1997 6 (6) 291-6 10 14. Clayton B D, Jorlzzo J L et al; adult pityriasis rubra pilarisa 10 years CiyclosporinA and azathioprine have also case series J AMm AcadDermatol,1997; 3: 959 -64 been used Emollients help in reducing scales. In 15. Jacyk W,k pityriasis rubra pilaris in black south Africans clin Exp circumscribed variety topical vitamin D analogues Dermatol 1999; 24 (3): 160-30 93 .
Load more

Recommended publications
  • Cutaneous Manifestations of COVID-19: a Systematic Review and Analysis of Individual Patient-Level Data
    Volume 26 Number 12| December 2020 Dermatology Online Journal || Review 26(12):2 Cutaneous manifestations of COVID-19: a systematic review and analysis of individual patient-level data David S Lee1 MD, Paradi Mirmirani2,3 MD, Patrick E McCleskey4 MD, Majid Mehrpouya5 PhD, Farzam Gorouhi6,7 MD Affiliations: 1Department of Dermatology, The Permanente Medical Group, Pleasanton, California, USA, 2Department of Dermatology, University of California, San Francisco, California, USA, 3Department of Dermatology, The Permanente Medical Group, Vallejo, California, USA, 4Department of Dermatology, The Permanente Medical Group, Oakland, California, USA, 5Faculty of Engineering, University of Calgary, Calgary, Alberta, Canada, 6Department of Dermatology, The Permanente Medical Group, South Sacramento, California, USA, 7Department of Dermatology, University of California, Davis, California, USA Corresponding Author: Farzam Gorouhi MD FAAD, Kaiser Permanente, South Sacramento, 6600 Bruceville Road, Sacramento, CA 95823, Tel: 415-298-1345, Email: [email protected] Introduction Abstract In December 2019, reports from Wuhan, China Distinctive patterns in the cutaneous manifestations described new clusters of patients with severe of COVID-19 have been recently reported. We pneumonia linked to a novel coronavirus strain, now conducted a systematic review to identify case reports and case series characterizing cutaneous referred to as severe acute respiratory syndrome manifestations of confirmed COVID-19. Key coronavirus 2 (SARS-CoV-2), [1]. Coronavirus disease demographic and clinical data from each case were 2019 (COVID-19) has since reached pandemic extracted and analyzed. The primary outcome proportions, with over 12·7 million cases worldwide, measure was risk factor analysis of skin related 566,000 deaths, and 188 countries affected at the outcomes for severe COVID-19 disease.
    [Show full text]
  • Tinea Versicolor Mimicking Pityriasis Rubra Pilaris
    Tinea Versicolor Mimicking Pityriasis Rubra Pilaris Capt Matthew J. Darling, MC, USAF; CPT Matthew C. Lambiase, MC, USA; Capt R. John Young, MC, USAF Tinea versicolor is a common noninvasive cuta- neous fungal disease. We recount a case of tinea versicolor that mimicked type I (classic adult) pityriasis rubra pilaris. A 54-year-old white man reported a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and treatment with oral antihistamines. Results of a skin examination revealed erythematous plaques; islands of spared skin; and follicular erythematous keratotic papules on the trunk, shoulders, and upper arms. A lesion was scraped to obtain skin scales for potassium hydroxide staining. Examination of the stained samples revealed the characteristic “spaghetti and meatballs,” confirming the diagnosis. Cutis. 2005;75:265-267. Case Report A 54-year-old white man presented with a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and oral antihistamine therapy. Erythem- atous scaly plaques were noted over the trunk and extremities (Figure 1). Islands of spared skin were most notable on the trunk (Figure 2). Follicular, erythematous, keratotic papules were noted on the shoulders and upper arms (Figure 3). Results of Wood lamp examination revealed a yellow-green Figure 1. Erythematous scaly plaques and islands of fluorescence of the plaques. Results of potassium spared skin on the chest. hydroxide (KOH) staining revealed numerous yeast and hyphae. The patient was diagnosed with tinea versicolor and treated with itraconazole 200 mg/d for 2 weeks.
    [Show full text]
  • Neonatal Dermatology Review
    NEONATAL Advanced Desert DERMATOLOGY Dermatology Jennifer Peterson Kevin Svancara Jonathan Bellew DISCLOSURES No relevant financial relationships to disclose Off-label use of acitretin in ichthyoses will be discussed PHYSIOLOGIC Vernix caseosa . Creamy biofilm . Present at birth . Opsonizing, antibacterial, antifungal, antiparasitic activity Cutis marmorata . Reticular, blanchable vascular mottling on extremities > trunk/face . Response to cold . Disappears on re-warming . Associations (if persistent) . Down syndrome . Trisomy 18 . Cornelia de Lange syndrome PHYSIOLOGIC Milia . Hard palate – Bohn’s nodules . Oral mucosa – Epstein pearls . Associations . Bazex-Dupre-Christol syndrome (XLD) . BCCs, follicular atrophoderma, hypohidrosis, hypotrichosis . Rombo syndrome . BCCs, vermiculate atrophoderma, trichoepitheliomas . Oro-facial-digital syndrome (type 1, XLD) . Basal cell nevus (Gorlin) syndrome . Brooke-Spiegler syndrome . Pachyonychia congenita type II (Jackson-Lawler) . Atrichia with papular lesions . Down syndrome . Secondary . Porphyria cutanea tarda . Epidermolysis bullosa TRANSIENT, NON-INFECTIOUS Transient neonatal pustular melanosis . Birth . Pustules hyperpigmented macules with collarette of scale . Resolve within 4 weeks . Neutrophils Erythema toxicum neonatorum . Full term . 24-48 hours . Erythematous macules, papules, pustules, wheals . Eosinophils Neonatal acne (neonatal cephalic pustulosis) . First 30 days . Malassezia globosa & sympoidalis overgrowth TRANSIENT, NON-INFECTIOUS Miliaria . First weeks . Eccrine
    [Show full text]
  • The Management of Common Skin Conditions in General Practice
    Management of Common Skin Conditions In General Practice including the “red rash made easy” © Arroll, Fishman & Oakley, Department of General Practice and Primary Health Care University of Auckland, Tamaki Campus Reviewed by Hon A/Prof Amanda Oakley - 2019 http://www.dermnetnz.org Management of Common Skin Conditions In General Practice Contents Page Derm Map 3 Classic location: infants & children 4 Classic location: adults 5 Dermatology terminology 6 Common red rashes 7 Other common skin conditions 12 Common viral infections 14 Common bacterial infections 16 Common fungal infections 17 Arthropods 19 Eczema/dermatitis 20 Benign skin lesions 23 Skin cancers 26 Emergency dermatology 28 Clinical diagnosis of melanoma 31 Principles of diagnosis and treatment 32 Principles of treatment of eczema 33 Treatment sequence for psoriasis 34 Topical corticosteroids 35 Combination topical steroid + antimicrobial 36 Safety with topical corticosteroids 36 Emollients 37 Antipruritics 38 For further information, refer to: http://www.dermnetnz.org And http://www.derm-master.com 2 © Arroll, Fishman & Oakley, Department of General Practice and Primary Health Care, University of Auckland, Tamaki Campus. Management of Common Skin Conditions In General Practice DERM MAP Start Is the patient sick ? Yes Rash could be an infection or a drug eruption? No Insect Bites – Crop of grouped papules with a central blister or scab. Is the patient in pain or the rash Yes Infection: cellulitis / erysipelas, impetigo, boil is swelling, oozing or crusting? / folliculitis, herpes simplex / zoster. Urticaria – Smooth skin surface with weals that evolve in minutes to hours. No Is the rash in a classic location? Yes See our classic location chart .
    [Show full text]
  • Autoinvolutive Photoexacerbated Tinea Corporis Mimicking a Subacute Cutaneous Lupus Erythematosus
    Letters to the Editor 141 low-potency steroids had no eŒect. Our patient was treated 4. Jarrat M, Ramsdell W. Infantile acropustulosis. Arch Dermatol with a modern glucocorticoid which has an improved risk– 1979; 115: 834–836. bene t ratio. The antipruritic and anti-in ammatory properties 5. Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol of the steroid were increased by applying it in combination 1979; 115: 831–833. 6. Newton JA, Salisbury J, Marsden A, McGibbon DH. with a wet-wrap technique, which has already been shown to Acropustulosis of infancy. Br J Dermatol 1986; 115: 735–739. be extremely helpful in cases of acute exacerbations of atopic 7. Mancini AJ, Frieden IJ, Praller AS. Infantile acropustulosis eczema in combination with (3) or even without topical revisited: history of scabies and response to topical corticosteroids. steroids (8). Pediatr Dermatol 1998; 15: 337–341. 8. Abeck D, Brockow K, Mempel M, Fesq H, Ring J. Treatment of acute exacerbated atopic eczema with emollient-antiseptic prepara- tions using ‘‘wet-wrap’’ (‘‘wet-pyjama’’) technique. Hautarzt 1999; REFERENCES 50: 418–421. 1. Vignon-Pennam en M-D, Wallach D. Infantile acropustulosis. Arch Dermatol 1986; 122: 1155–1160. Accepted November 24, 2000. 2. Duvanel T, Harms M. Infantile Akropustulose. Hautarzt 1988; 39: 1–4. Markus Braun-Falco, Silke Stachowitz, Christina Schnopp, Johannes 3. Oranje AP, Wolkerstorfer A, de Waard-van der Spek FB. Treatment Ring and Dietrich Abeck of erythrodermic atopic dermatitis with ‘‘wet-wrap’’ uticasone Klinik und Poliklinik fu¨r Dermatologie und Allergologie am propionate 0,05% cream/emollient 1:1 dressing.
    [Show full text]
  • Cytomegalovirus Infection Associated with Portal Vein Thrombosis and Thrombocytopenia: a Case Report
    MÉDECINE INTERNE Cytomegalovirus infection associated with portal vein thrombosis and thrombocytopenia: a case report Gianfranco Di Prinzio1, Phung Nguyen Ung2, Anne-Sophie Valschaerts2, Olivier Borgniet2 CMV et Thrombose : We here present the case of portal vein thrombosis in a patient exhibiting symptoms of cytomegalovirus infection, confirmed by un binome sous-estimé serology and polymerase chain reaction (PCR) and complicated by Le Cytomegalovirus (CMV) est thrombocytopenia. The literature reveals growing evidence that responsable d’une infection virale human CMV likely plays a role in thrombotic disorders. However, commune et souvent banale chez le only 11 cases of CMV-induced visceral venous thrombosis have been sujet immunocompétent, mais qui described so far. On the other hand, thrombocytopenia is a well- n’est pas dépourvue de complications potentiellement graves. La thrombose known complication of CMV infection. The patient was successfully porte en est un exemple. Le cas que treated using high-dose immunoglobulins by intravenous route. nous décrivons concerne une patiente atteinte d’une infection à CMV, s’étant révélée par une éruption cutanée et s’étant compliquée d’une thrombose porte, en l’absence de thrombophilie connue. Une thrombopénie auto- A 36-year-old Caucasian woman was admitted to the emergency room immune est la seconde complication of our hospital, complaining since several days of sore throat, cough, survenue dans notre cas. Cet article a pour but de souligner l’enjeu d’un tel fever, headache, and rhinorrhea. She had been unsuccessfully treated diagnostic et de stimuler la réflexion sur with amoxicillin-clavulanate during the week preceding her admission. l’intérêt du dépistage échographique The medication was stopped owing to gastric intolerance.
    [Show full text]
  • Erythema Annulare Centrifugum ▪ Erythema Gyratum Repens ▪ Exfoliative Erythroderma Urticaria ▪ COMMON: 15% All Americans
    Cutaneous Signs of Internal Malignancy Ted Rosen, MD Professor of Dermatology Baylor College of Medicine Disclosure/Conflict of Interest ▪ No relevant disclosures ▪ No conflicts of interest Objectives ▪ Recognize common disorders associated with internal malignancy ▪ Manage cutaneous disorders in the context of associated internal malignancy ▪ Differentiate cutaneous signs of leukemia and lymphoma ▪ Understand spidemiology of cutaneous metastases Cutaneous Signs of Internal Malignancy ▪ General physical examination ▪ Pallor (anemia) ▪ Jaundice (hepatic or cholestatic disease) ▪ Fixed erythema or flushing (carcinoid) ▪ Alopecia (diffuse metastatic disease) ▪ Itching (excoriations) Anemia: Conjunctival pallor and Pale skin Jaundice 1-12% of hepatocellular, biliary tree or pancreatic cancer PRESENT with jaundice, but up to 40-60% eventually develop it World J Gastroenterol 2003;9:385-91 For comparison CAN YOU TELL JAUNDICE FROM NORMAL SKIN? JAUNDICE Alopecia Neoplastica Most common report w/ breast CA Lung, cervix, desmoplastic mm Hair loss w/ underlying induration Biopsy = dermis effaced by tumor Ann Dermatol 26:624, 2014 South Med J 102:385, 2009 Int J Dermatol 46:188, 2007 Acta Derm Venereol 87:93, 2007 J Eur Acad Derm Venereol 18:708, 2004 Gastric Adenocarcinoma: Alopecia Ann Dermatol 2014; 26: 624–627 Pruritus: Excoriation ▪ Overall risk internal malignancy presenting as itch LOW. OR =1.14 ▪ CTCL, Hodgkin’s & NHL, Polycythemia vera ▪ Biliary tree carcinoma Eur J Pain 20:19-23, 2016 Br J Dermatol 171:839-46, 2014 J Am Acad Dermatol 70:651-8, 2014 Non-specific (Paraneoplastic) Specific (Metastatic Disease) Paraneoplastic Signs “Curth’s Postulates” ▪ Concurrent onset (temporal proximity) ▪ Parallel course ▪ Uniform site or type of neoplasm ▪ Statistical association ▪ Genetic linkage (syndromal) Curth HO.
    [Show full text]
  • Causes and Features of Erythroderma 1 1 2 1 Grace FL Tan, MBBS, Yan Ling Kong, MBBS, Andy SL Tan, MBBS, MPH, Hong Liang Tey, MBBS, MRCP(UK), FAMS
    391 Erythroderma: Causes and Features—Grace FL Tan et al Original Article Causes and Features of Erythroderma 1 1 2 1 Grace FL Tan, MBBS, Yan Ling Kong, MBBS, Andy SL Tan, MBBS, MPH, Hong Liang Tey, MBBS, MRCP(UK), FAMS Abstract Introduction: Erythroderma is a generalised infl ammatory reaction of the skin secondary to a variety of causes. This retrospective study aims to characterise the features of erythroderma and identify the associated causes of this condition in our population. Materials and Methods: We reviewed the clinical, laboratory, histological and other disease-specifi c investigations of 225 inpatients and outpatients with erythroderma over a 7.5-year period between January 2005 and June 2012. Results: The most common causative factors were underlying dermatoses (68.9%), idiopathic causes (14.2%), drug reactions (10.7%), and malignancies (4.0%). When drugs and underlying dermatoses were excluded, malignancy-associated cases constituted 19.6% of the cases. Fifty-fi ve percent of malignancies were solid-organ malignancies, which is much higher than those previously reported (0.0% to 25%). Endogenous eczema was the most common dermatoses (69.0%), while traditional medications (20.8%) and anti-tuberculous medications (16.7%) were commonly implicated drugs. In patients with cutaneous T-cell lymphoma (CTCL), skin biopsy was suggestive or diagnostic in all cases. A total of 52.4% of patients with drug-related erythroderma had eosinophilia on skin biopsy. Electrolyte abnormalities and renal impairment were seen in 26.2% and 16.9% of patients respectively. Relapse rate at 1-year was 17.8%, with no associated mortality.
    [Show full text]
  • Pityriasis Rosea Following Influenza
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector Available online at www.sciencedirect.com Journal of the Chinese Medical Association 74 (2011) 280e282 www.jcma-online.com Case Report Pityriasis rosea following influenza (H1N1) vaccination Jeng-Feng Chen, Chien-Ping Chiang, Yu-Fei Chen, Wei-Ming Wang* Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC Received May 3, 2010; accepted November 13, 2010 Abstract Pityriasis rosea is a distinct papulosquamous skin eruption that has been attributed to viral reactivation, certain drug exposures or rarely, vaccination. Herein, we reported a clinicopathlogically typical case of pityriasis rosea that developed after the H1N1 vaccination. With a global H1N1 vaccination program against the pandemic H1N1 influenza, patients should be apprised of the possibility of such rare but benign skin reaction to avoid unnecessary fear. Furthermore, a brief review of the current reported skin adverse events related to the novel H1N1 vaccination in Taiwan is presented here. Copyright Ó 2011 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved. Keywords: Adverse reaction; H1N1 vaccination; Pandemic; Pityriasis rosea 1. Introduction a herald skin lesion was spotted initially in his left upper thigh followed several days later by the onset of many itchy scaly Pityriasis rosea (PR) is an acute, self-limited, papulosqu- lesions on his trunk and proximal extremities. The first herald amous skin eruption that occurs most commonly among patch developed five days after he underwent H1N1 vaccina- teenagers and young adults.1 Typical clinical presentation is tion (AdimFlu-S (A-H1N1), Adimmune, Taichung, Taiwan).
    [Show full text]
  • Pityriasis Rubra Pilaris: a Rare Inflammatory Dermatosis Aine Kelly, Aoife Lally
    BMJ Case Reports: first published as 10.1136/bcr-2017-224007 on 11 February 2018. Downloaded from Images in… Pityriasis rubra pilaris: a rare inflammatory dermatosis Aine Kelly, Aoife Lally Department of Dermatology, St DESCRIPTION Vincent’s University Hospital, An 18-year-old Caucasian woman presented with Dublin, Ireland a 2-week history of a pruritic rash commencing on the face and spreading distally to the trunk Correspondence to and limbs. There were no associated systemic Dr Aine Kelly, 107545606@ umail. ucc. ie symptoms. Her medical history was unremark- able and there was a family history of hypothy- Accepted 19 January 2018 roidism. Physical examination revealed extensive confluent scaly erythema with islands of sparing on the trunk and scaling of the scalp. There was hyperkeratotic plugging of the hair follicles (figure 1 and figure 2). There was a waxy orange keratoderma affecting the palms and soles with associated painful fissuring (figure 3). A clinical Figure 2 Close-up view of trunk showing small diagnosis of pityriasis rubra pilaris (PRP) was follicular papules with central keratin plug. made. Histopathology of involved skin showed focal parakeratosis and orthokeratosis alter- nating in both horizontal and vertical directions with an underlying perivascular inflammatory infiltrate. The patient had a raised thyroid stimu- lating hormone (TSH) and normal T4 indicative of subclinical hypothyroidism. Treatment for her skin was initiated with methotrexate and titrated to a dose of 15 mg weekly. There was complete http://casereports.bmj.com/ Figure 3 Waxy orange keratoderma affecting the palms and soles with associated painful fissuring. remission at 16 weeks. This case fits the descrip- tion of classical adult-type PRP.
    [Show full text]
  • Treatment of Refractory Pityriasis Rubra Pilaris with Novel Phosphodiesterase 4
    Letters Discussion | Acrodermatitis continua of Hallopeau, also Additional Contributions: We thank the patient for granting permission to known as acrodermatitis perstans and dermatitis repens, publish this information. is a rare inflammatory pustular dermatosis of the distal fin- 1. Saunier J, Debarbieux S, Jullien D, Garnier L, Dalle S, Thomas L. Acrodermatitis continua of Hallopeau treated successfully with ustekinumab gers and toes. It is considered a variant of pustular psoriasis and acitretin after failure of tumour necrosis factor blockade and anakinra. or, less commonly, its own pustular psoriasis-like indepen- Dermatology. 2015;230(2):97-100. 1 dent entity. Precise pathophysiology and incidence 2. Kiszewski AE, De Villa D, Scheibel I, Ricachnevsky N. An infant with are unknown. Case literature suggests predominance in acrodermatitis continua of Hallopeau: successful treatment with thalidomide women, but the disease affects both sexes and, rarely, and UVB therapy. Pediatr Dermatol. 2009;26(1):105-106. children.2 3. Jo SJ, Park JY, Yoon HS, Youn JI. Case of acrodermatitis continua accompanied by psoriatic arthritis. J Dermatol. 2006;33(11):787-791. Acrodermatitis continua of Hallopeau initially presents 4. Sehgal VN, Verma P, Sharma S, et al. Acrodermatitis continua of Hallopeau: as erythema overlying the distal digits that evolves into evolution of treatment options. Int J Dermatol. 2011;50(10):1195-1211. pustules.2 The nail bed is often involved, with paronychial 5. Lutz V, Lipsker D. Acitretin- and tumor necrosis factor inhibitor-resistant 3 and subungual involvement and atrophic skin changes. acrodermatitis continua of Hallopeau responsive to the interleukin 1 receptor Most patients experience a chronic, relapsing course involv- antagonist anakinra.
    [Show full text]
  • Successful Treatment of Refractory Pityriasis Rubra Pilaris With
    Letters Discussion | The results of this study reveal important differ- OBSERVATION ences in the microbiota of HS lesions in obese vs nonobese pa- tients. Gut flora alterations are seen in obese patients,4,5 and Successful Treatment of Refractory Pityriasis HS has been associated with obesity. It is possible that altered Rubra Pilaris With Secukinumab gut or skin flora could have a pathogenic role in HS. Pityriasis rubra pilaris (PRP) is a rare inflammatory skin dis- Some of the limitations of the present study include the order of unknown cause. It is characterized by follicular use of retrospective data and the lack of a control group con- hyperkeratosis, scaly erythematous plaques, palmoplantar sisting of patients with no history of HS. Although these cul- keratoderma, and frequent progression to generalized tures were obtained from purulence extruding from HS le- erythroderma.1 Six types of PRP are distinguished, with type sions, the bacterial culture results could represent skin or gut 1 being the most common form in adults. Disease manage- flora contamination. Information about the specific ana- ment of PRP is challenging for lack of specific guidelines. Topi- tomic locations of HS cultures was not available. Because only cal emollients, corticosteroids, and salicylic acid alone or com- the first recorded culture of each patient was analyzed, it is un- bined with systemic retinoids, methotrexate, and tumor known if the culture results would change with time and fur- necrosis factor (TNF) inhibitors are considered to be most ther antibiotic therapy. The use of data obtained from swab- helpful.2,3 Unfortunately, PRP often resists conventional treat- based cultures may also represent a potential limitation because ment.
    [Show full text]