Open AccessSevere, Disfiguring, Pityriasis Rubra Pilaris in a Woman in the Dominican Republic
Author(s) -
Leonel Lerebours-Nadal,
Consuelo M. Beck-Sague,
Darien Parker,
Amanda Gosman,
Arturo Saavedra,
Kristy Engel,
Andrew G. Dean
Publication year - 2015
Publication title -
journal of the international association of providers of aids care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.813
H-Index - 31
eISSN - 2325-9582
pISSN - 2325-9574
DOI - 10.1177/2325957415614649
Subject(s) - pityriasis rubra pilaris , erythroderma , dermatology , scalp , medicine , wasting , rash , keratoderma , hyperkeratosis , psoriasis
Pityriasis rubra pilaris (PRP) is a poorly understood dermatologic condition usually accompanied by keratoderma and intense erythroderma with islands of unaffected skin. The PRP categories include HIV-associated PRP VI. A 23-year-old HIV-infected, dark-skinned woman in the Dominican Republic developed an extremely severe, disfiguring process characterized first by a dry scaly rash involving her face, trunk, and extremities with hyperpigmentation and islands of spared skin and minimal erythroderma, followed by alopecia and development of a thick horny layer on the scalp and face. The condition, histologically proven to be PRP, was accompanied by fever, wasting, and decline in CD4 count. Initiation of combination antiretroviral therapy (cART) was followed by rapid and sustained resolution of PRP. Nine years after ART initiation, she remains well, with viral suppression and immune recovery, without PRP recurrence but with sparse hair regrowth and facial scarring. In some dark-skinned patients, severe PRP may not feature characteristic erythroderma but will respond to combination ART.