TREATMENT OF CLASSIC PITYRIASIS-RUBRA-PILARIS

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.