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Treatment of classic pityriasis rubra pilaris
1Department of Dermatology, Mayo Clinic, Rochester, MN 55905.
Background:
Treatment of classic pityriasis rubra pilaris, which almost always progresses to a generalized erythroderma with marked, often disabling keratoderma of the palms and soles, remains problematic.
Objective:
Our purpose was to evaluate the results of treatment in a recent period during which the retinoid group of drugs has been available.
Methods:
The clinical course of 75 patients with classic pityriasis rubra pilaris seen from 1982 to 1992 was reviewed.
Results:
Of 15 patients treated with isotretinoin, 10 had complete and 2 had partial clearing. Of six treated with etretinate, four had clearing. All eight patients treated with methotrexate had a favorable response. Other forms of treatment, including Goeckerman regimen, corticosteroids, vitamin A, and cyclosporine, were ineffective.
Conclusion:
Early diagnosis and early treatment with retinoids appear to offer the best chance for clearing of pityriasis rubra pilaris. If retinoids fail or cannot be used, methotrexate should be considered.