Beyond plaque psoriasis – pathogenesis and treatment of other psoriasis phenotypes

Abstract

Purpose of reviewPsoriasis vulgaris is the commonest presentation of psoriatic disease, but morphologic variants such as pustular psoriasis (PP) and a closely related disease, pityriasis rubra pilaris (PRP), have been known for a long time, have been associated with rheumatologic manifestations indistinguishable from psoriatic arthritis (PsA) that may go unrecognized, and often represent a therapeutic conundrum. There is recent evidence that underlying genetic and pathogenetic differences may provide the basis for newer therapeutic approaches.Recent findingsThis narrative review highlights the clinical, genetic and pathogenetic characteristics of PP and PRP, their association with PsA and recent developments in their treatment, especially with biologic agents targeting IL-36 and other cytokines of pathogenic relevance.SummaryThe clinical manifestations of PP and PRP are less well known to rheumatologists than those of psoriasis, and recent advances in our insight on their pathogenesis may eventually overcome the therapeutic difficulties faced by dermatologists and rheumatologists in the management of these diseases and their rheumatologic manifestations.

Pityriasis rubra pilaris type IV‐associated arthritis treated with adalimumab

“…1 The relationship between variants of psoriasis such as pustular psoriasis and another disease in the psoriatic disease group, PRP, in terms of rheumatological manifestations has not been sufficiently emphasized. 1,3,4 Nail changes such as pitting, ridging and subungual hyperkeratosis are seen in PRP cases as well as in psoriasis. 1,2 The clinical similarity of psoriasis and PRP and better knowledge of the rheumatological manifestations of psoriasis bring along some problems.…”

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Pityriasis rubra pilaris (PRP) is a rare disease, the etiology of which has not been fully elucidated, and may cause hyperkeratotic follicular papules, erythematous-squamous plaques and nail changes. 1 According to the widely accepted classification, there are 6 types of PRP. The human immunodeficiency virus-related type was added in addition to the 5 types determined based on clinical features, age of onset, and prognosis.

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“…2 Type IV circumscribed juvenile PRP is mostly seen in adolescence and characterized by sharply demarcated erythema and follicular hyperkeratosis located on the knees and elbows. 1,2 Few cases of arthritis associated with this disease, which is clinically similar to psoriasis, have been reported. [3][4][5][6] Currently, there is no standard treatment algorithm or guideline for PRP and PRPassociated arthritis.…”

A Familial Novel Putative-Pathogenic Mutation Identified in Plaque-Psoriasis by a Multigene Panel Analysis

“…Disease classification is based on clinical appearance, which mainly differs depending on localization and morphology. There are four main forms of psoriasis: plaque-type, guttate, generalized pustular psoriasis and erythroderma [11,12]. Plaque-type psoriasis, which occurs in 85-90% of affected patients, is the most common form of psoriasis and it is characterized by oval or irregularly shaped, red, sharply demarcated raised plaques covered by silvery scales.…”

Anti-interleukin-17A for pityriasis rubra pilaris: catching the psoriasis biologic wave

“…Pityriasis rubra pilaris (PRP) is a rare skin disease belonging to the spectrum of psoriasiform dermatoses 1 . Initially, PRP was considered a psoriasis variant until it achieved status as a distinct disease by the end of the 19th century 2 .…”