Drug-related pityriasis rubra pilaris with acantholysis

Abstract

Introduction. Acantholysis is rarely reported histological feature of Pityriasis rubra pilaris (PRP), recently recognized as having diagnostic specificity for differentiating PRP from psoriasis. Case report. Adult male patient one week after the introduction of simvastatin had experienced pruritic erythemo-squamous eruption on head and upper trunk that in a month progressed to erythrodermia, with islands of sparing. Histological picture combined pemphigus-like acantholysis with alternating hyper- and parakeratosis, follicular plugs and dermal inflammation, and confirmed the clinical diagnosis of classic adult type 1 PRP. Acitretin therapy resulted in a resolution of skin disease. Patch test with simvastatin was negative, scratch test was positive, and it was estimated that potential risk of oral challenge with simvastatin outweighed actual need for it. Drug triggering PRP episode is the most likely explanation for temporal relation between the start of simvastatin treatment and skin eruption. Conclusion. In management of rare inflammatory skin disease, such as PRP, we have to carefully observe and evaluate not only diagnostic features but possible external influences on its course also

The Incidence of Acantholysis in Pityriasis Rubra Pilaris—Histopathological Study Using Multiple-Step Sections and Clinicopathologic Correlations

“…In addition, there were reports of selected or collected PRP cases with acantholysis adding up to 27 of 47 (mean: 57%) biopsies with acantholysis. 2,[5][6][7][8][9][10][11][12][13]15 Acantholysis was not present in the initial sections of any of our PRP biopsies, but in 6.5%-46% (mean: 31%) of the step sections of 5 biopsies, suggesting that acantholysis may not be a constant histopathological characteristic of PRP, and it may be present in only the minority of the sections.…”

“…Proteolytic enzymes were speculated as causative agents, 2,11 in accordance with the nonspecific pattern of acantholysis seen in our cases and in previous ones. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] Understanding the mechanism of acantholysis may shed more light on the molecular basis and the pathogenesis of PRP.…”

Pityriasis Rubra Pilaris: A Report of Two Cases and Literature Review

“…Our patients presented ustekinumab, adalimumab (18,20,22,42,(44)(45)(46)(47). Phototherapy (UVB, NB UVB, PUVA) can be eff ective as monotherapy, or combined with retinoids (48).…”

Atorvastatin-induced Lichenoid Drug Eruption: A Case Report and Review of Statin-associated Cutaneous Adverse Events

“…Acute generalized exanthematous pustulosis [1] Alopecia [2] Angioedema [1] Bullous dermatosis [3] Cheilitis [4] Chronic actinic dermatitis [1] Cutaneous lupus erythematosus [5] Dermatographism [1] Dermatomyositis [6] Eczema [1] Eosinophilic fasciitis [1] Erythema multiforme [7] Ichthyosis [1] Lichenoid drug eruptions [13][14][15][16][17][18]CR] Lichen planus pemphigoides [1] Phototoxicity [1] Pityriasis lichenoides chronica [8] Pityriasis rubra pilaris [9] Porphyria cutanea tarda [10] Purpuric lesions [11] Skin ulcers [12] Toxic epidermal necrolysis [1] Lichenoid drug eruptions have historically been associated with antimalarials, gold, and penicillamine. More recently, they have been observed with antineoplastics, beta-blockers, and thiazides [16].…”

“…However, statins can have a diverse array of effects beyond lowering the risk of cardiovascular disease [1]. Statins have been associated with various adverse cutaneous side effects including alopecia, bullous dermatosis, and lichenoid drug eruptions [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Lichenoid drug eruptions clinically mimic idiopathic lichen planus [19].…”