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A Review on Pityriasis Rubra Pilaris

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Abstract

Pityriasis rubra pilaris (PRP) is an idiopathic, papulosquamous inflammatory dermatosis. It is characterized by hyperkeratotic follicular papules coalescing into orange-red scaly plaques, islands of sparing, and palmoplantar keratoderma. PRP can be subdivided into six clinical subtypes according to Griffiths’ classification, based on age of onset, disease extent, prognosis, and other associated features. The sixth subtype of PRP occurs in individuals affected by HIV infection, and retroviral screening in all de novo cases of PRP is advised. Other reported associations include various infections, autoimmunity, drugs, and malignancies, although the true significance of these is still unclear. The genetic basis for familial cases, most commonly categorized under the fifth subtype, has been mapped to gain of function mutations in the caspase recruitment domain family, member 14 (CARD14) gene. Treatment of PRP remains a challenge to this day due to a paucity of high-quality evidence. Therapeutic regimens have been guided mostly by case reports and case series, with the mainstay of treatment being oral retinoids. Recently, biologics have emerged as a promising treatment for PRP. We present a review of the clinicopathologic features, pathogenesis, associated disorders, and treatment of PRP, with an emphasis and critical appraisal of the existing literature on the latter.

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  1. Drs. Dingyuan Wang and Vanessa Cui-Lian Chong contributed equally as first authors.

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  1. National Skin Centre, 1 Mandalay Rd, Singapore, 308205, Republic of Singapore

    Dingyuan Wang, Vanessa Cui-Lian Chong, Wei-Sheng Chong & Hazel H. Oon

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Dr. Hazel H. Oon is a clinical investigator for Janssen, Novartis, and Pfizer, and an advisory board member for AbbVie. Dr. Oon has also served as a speaker, advisory board member, and researcher for Galderma. Drs. V. C. L. Chong, D. Y. Wang, and W.S. Chong do not have any conflicts of interest to declare.

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Wang, D., Chong, V.CL., Chong, WS. et al. A Review on Pityriasis Rubra Pilaris. Am J Clin Dermatol 19, 377–390 (2018). https://doi.org/10.1007/s40257-017-0338-1

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