Successful treatment of type I adult‐onset pityriasis rubra pilaris with infliximab

Abstract

A 59-year-old woman presented with a painful, pruritic eruption that had commenced as an erythematous, dry patch on the upper back but progressed to erythroderma. Examination revealed orange-tinged erythroderma, scalp scaling, ectropion, palmoplantar keratoderma and nail changes. A diagnosis of type I adult-onset pityriasis rubra pilaris was made, and a subsequent skin biopsy was consistent with this. She was treated with a number of topical and systemic agents with minimal improvement or major side-effects. The patient was then treated with intravenous infliximab 5 mg/kg. She improved dramatically within 2 weeks and was no longer erythrodermic. Five further infusions resulted in additional improvement. Methotrexate was briefly added to the regime, but was ceased owing to nausea. Topical tar and keratolytics were used on the scalp. The patient was left with minimal disease activity and was maintained on emollients.

Infliximab monotherapy as first-line treatment for adult-onset pityriasis rubra pilaris: Case report and review of the literature on biologic therapy

“…One patient with type I PRP recalcitrant to MTX, acitretin, fumaric acid, and mycophenolate mofetil therapy for 8 months showed a dramatic and persistent improvement after the first infusion. 9 Presently, the most recent successful infliximab use has been shown in a patient after ineffective pretreatment with cyclosporine and acitretin therapy. 10 Though infliximab has shown clinical efficacy in the above listed cases, Lu et al 11 presented a case unresponsive to combination infliximab and acitretin therapy.…”

Effectiveness of Infliximab in Pityriasis Rubra Pilaris Is Associated with Pro-Inflammatory Cytokine Inhibition

“…In recent years, biologics have been used in the treatment of the classical, generalized type of PRP in isolated cases. To date, 20 patients with PRP have successfully been treated with infliximab [9,13,14,15,16,22,25], 10 with etanercept [10,12,21,22,23], 7 with adalimumab [8,11,18,20,26] and 2 with ustekinumab [17,19]. Treatment with biologics was found ineffective in only 2 patients with PRP: 1 patient treated with efalizumab [27] and another treated with infliximab and acitretin [28].…”

“…topical corticosteroids, vitamin D analogues, PUVA and methotrexate, are used, but are generally not efficient or restricted by side effects (acitretin, cyclosporine). Recently, the effectiveness of TNF-α antagonists, now routinely used in psoriasis (infliximab, etanercept, adalimumab), has been reported in isolated case reports, and sometimes after failure of previous treatments [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. To date, the use of anti-TNF-α therapies in PRP has not been based on a pathophysiological rationale.…”

Pityriasis Rubra Pilaris: Treatment with Biologics – A New Promising Therapy?

“…Between 2003 and 2010, 13 patients have been published who underwent successful treatment with infliximab with 2–8 infusions at a dose of 5 mg/kg in variable intervals [23,24,25,26,27]. Eight of these patients had adjunctive treatment with acitretin, cyclosporine, methotrexate, UVB, and systemic or topical glucocorticosteroids.…”