Pityriasis rubra pilaris (PRP) is a rare chronic papulosquamous disorder of unknown cause characterized by erythematous scaly plaques, palmoplantar keratoderma, and keratotic follicular papules. The disease can be intensely painful, disabling, and difficult to treat. We report the first case of PRP treated successfully with combination etanercept and acitretin therapy.
A 55-year-old man presented with a large erythematous scaly patch on his right temple and scalp. Clinical appearance and skin biopsy findings led to the diagnosis of adult-onset type 1 PRP. Over the next 8 months, the plaques gradually spread to cover his chest, back, arms, legs, palms, and the soles of his feet, eventually covering an estimated 90% of his body surface area (Figure 1).
Davis KF, Wu JJ, Murase JE, Rosenberg FR, Sorenson EP, Meshkinpour A. Clinical Improvement of Pityriasis Rubra Pilaris With Combination Etanercept and Acitretin Therapy. Arch Dermatol. 2007;143(12):1589-1603. doi:10.1001/archderm.143.12.1597