American Journal of Clinical Dermatology

, Volume 11, Issue 3, pp 157–170

Pityriasis Rubra Pilaris

A Review of Diagnosis and Treatment
Review Article Pityriasis Rubra Pilaris

DOI: 10.2165/11530070-000000000-00000

Cite this article as:
Klein, A., Landthaler, M. & Karrer, S. Am J Clin Dermatol (2010) 11: 157. doi:10.2165/11530070-000000000-00000


Pityriasis rubra pilaris (PRP) is a rare inflammatory dermatosis of unknown etiology, and finding a successful therapy can be challenging. PRP occurs equally in men and women. In some patients, associated autoimmune diseases, infections, or malignancies are possible trigger factors. PRP shows a bimodal age distribution, peaking in the first as well as in the fifth to sixth decade. Its classification into five subgroups is based on age at onset, clinical course, morphologic features, and prognosis. More than 50% of patients are best classified as type I with adult-onset PRP. This form is also characterized by high spontaneous remission rates (80%) within 1–3 years. Clinically, the classical adult (type I) and classical juvenile (type III) forms appear to be the same except for the patient’s age. Recently, the designation of a new category of PRP (type VI) has been proposed that is characterized by the presence of HIV infection with different clinical features and a poorer prognosis. Typical morphologic features of PRP are erythematosquamous salmon-colored plaques with well demarcated islands of unaffected skin. Often, keratoderma of the palms and soles is present. In patients with extensive disease, ectropion is a dreaded complication. Histology shows hyperkeratosis, alternating orthokeratosis and parakeratosis in a checkerboard pattern, and focal acantholytic dyskeratosis.

Descriptions and therapeutic experiences are mainly based on case reports. Mostly, systemic retinoids, methotrexate, and other immunosuppressive agents as well as UV light therapy are applied, with varying response rates. In recent years, treatment with so-called ‘biologics’ is becoming more and more popular for treating recalcitrant PRP.

We present a review of the clinical features, histopathologic findings, classification, differential diagnoses, and treatment of PRP.

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Annette Klein
    • 1
  • Michael Landthaler
    • 1
  • Sigrid Karrer
    • 1
  1. 1.Department of DermatologyUniversity of RegensburgRegensburgGermany