Pityriasis Rubra Pilaris: An Unusual Case. Presented by Irwin Braverman, MD.
A 37-year-old white woman developed a pruritic erythematous lesion on her right breast 17 years ago that slowly spread to involve most of her body, but spared the palms and soles. Scalp lesions appeared ten years ago as crusting, pruritic areas that evolved into scarring alopecia. She has been treated with electron beam therapy, prednisone, vitamin A, methotrexate, and flurandrenolide cream. Family history was noncontributory.Examination revealed scarring alopecia over the central portion of the scalp. Perifollicular, hyperkeratotic lesions were present over the entire surface of her body, particularly the extensor surfaces of the extremities, the belt line, the upper anterior chest, and the buttocks. Small hyperkeratotic plaques with "carpet tacking" and surrounding erythema were localized to the nose and malar areas.Laboratory data were normal except for eosinophilia. D-xylose and vitamin A absorption tests were normal.Pathologic findings