ABSTRACT
The clinical and histopathological diagnosis of pityriasis rubra pilaris (PRP) can be difficult because clinical findings are often subtle in early stages, and microscopic findings can overlap with those of other skin diseases. Focal acantholytic dyskeratosis (FAD) can rarely be seen in PRP and can mimic Darier's disease, Grover's disease or other disorders characterized by these histopathologic features. Kaposi's varicelliform eruption is a widespread infection due to herpes simplex virus (HSV) types 1 and 2, coxsackievirus A16 or vaccinia virus, occurring in a preexisting dermatosis; only one case has been reported in PRP. We report a patient with PRP whose biopsies showed both herpes simplex infection and FAD. A complete understanding of the mechanism behind this eruption evolved gradually, aided in great measure by the histopathologic findings.
Subject(s)
Darier Disease/diagnosis , Herpes Simplex/pathology , Kaposi Varicelliform Eruption/pathology , Pityriasis Rubra Pilaris/diagnosis , Acantholysis/diagnosis , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Aged , Antiviral Agents/therapeutic use , Darier Disease/drug therapy , Darier Disease/virology , Diagnosis, Differential , Herpes Simplex/complications , Herpes Simplex/drug therapy , Humans , Ichthyosis/diagnosis , Kaposi Varicelliform Eruption/drug therapy , Kaposi Varicelliform Eruption/virology , Male , Methotrexate/therapeutic use , Pityriasis Rubra Pilaris/drug therapy , Pityriasis Rubra Pilaris/virology , Valacyclovir , Valine/analogs & derivatives , Valine/therapeutic useABSTRACT
Pityriasis rubra pilaris (PRP) is a papulosquamous disorder comprising 6 clinical types. Some factors - including abnormal vitamin A metabolism, internal malignancies, autoimmune diseases, infection and trauma - are thought to be involved in the etiology. Recently, human immunodeficiency virus (HIV)-associated PRP has been reported to have distinct clinical features, such as nodulocystic acne and lichen spinulosus alongside PRP. We report here the case of a 38-year-old female with onset of classical PRP after a high fever. Virological studies indicated that the patient had primary systemic cytomegalovirus (CMV) infection and not HIV infection. Our case suggested that primary CMV infection might have triggered typical PRP that was clinically different from HIV-associated PRP.
Subject(s)
Cytomegalovirus Infections/complications , Pityriasis Rubra Pilaris/virology , Adult , Biopsy , Cytomegalovirus Infections/pathology , Cytomegalovirus Infections/therapy , Female , Humans , Pityriasis Rubra Pilaris/pathology , Pityriasis Rubra Pilaris/therapy , Risk Factors , Treatment OutcomeABSTRACT
A 24-year-old male boy presented dermatosis which first appeared acutely after an infection at age 17. Clinical and histopathologic examinations were consistent with a diagnosis of juvenile pityriasis rubra pilaris type III. Treatment with UVB narrow-band led to complete resolution of the dermatitis within 1 year. Pityriasis rubra pilaris is a papulosquamous disorder of unknown etiology, which can be treated with retinoids, methotrexate, cyclosporine, and narrow-band phototherapy.
