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.