Pityriasis rubra pilaris (PRP) is a rare heterogeneous group of papulosquamous inflammatory disorders with unknown etiology. PRP is often resistant to many conventional therapies which has made more challenging on treatment. More recently, several studies have shown encouraging clinical results of secukinumab in the treatment of PRP in adult, but no studies have explored its effects in children. We herein report a 7-year-old boy with severe type V PRP responded rapidly to secukinumab monotherapy (150 mg once weekly) when conventional therapies have failed. The patient showed rapid and dramatic improvement of erythema, palmoplantar hyperkeratosis, scaling, and itching within only 5 weeks, with no adverse effects. Secukinumab could be considered as a treatment option for refractory PRP in children, as recently reported in adult. K E Y W O R D S monotherapy, pityriasis rubra pilaris, secukinumab 1 | INTRODUCTION Pityriasis rubra pilaris (PRP) is an uncommon papulosquamous inflammatory disorder characterized by red-orange scaling erythema, follicular keratotic papules, and palmoplantar hyperkeratosis. 1 According to age at onset, clinical features, and prognosis, PRP can been subdivided into five clinical types: adult-onset PRP (classical, type I; atypical, type II) and juvenile-onset PRP (classical, type III; circumscribed, type IV; atypical, type V). 2 Type V PRP is clinically similar to type II PRP except for different onset ages, which are both typified by ichthyosiform features and usually chronic intractable, accounting, respectively, for about 5% of all cases. 1 The therapy in children is sometimes based on research and clinical experience from adults. More recently, secukinumab, an anti-IL-17A monoclonal antibody, has been showed promising results in small series and case reports in adult PRP. In this study, we present a 7-year-old boy with severe atypical juvenile PRP (type V) successfully treated with secukinumab alone who had an unsatisfactory response to first-and second-line treatment, and review all relevant cases reported in the English literature. 2 | CASE REPORT A 7-year-old Chinese boy presented with generalized erythematous plaques and scaly eruption which started on head and trunk during first month after the birth and progressed to involve his entire body. He was diagnosed as atopic dermatitis and generalized pustular psoriasis by other hospitals, and has tried different treatments such as topical corticosteroids, calcineurin inhibitors, systemic methotrexate, and acitretin without any significant benefit. Physical examination revealed confluent ichthyosiform erythematous eruption all over his body with a large amount of scales, both upper eyelids welling and ectropion with incomplete closure, conjunctiva congestion, radial wrinkles around his month, thick palmoplantar Jing-yao Liang and Rui-xian Ye have contributed equally to this study.
