A Pediatric Case of Pityriasis Rubra Pilaris Successfully Treated with Low-Dose Vitamin A

Abstract

Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory keratosis that is clinically characterized by gradually developing reddish or orange extending plaques and keratotic follicular papules. In pediatric patients, we frequently hesitate to administer certain medications for treatment of PRP, specifically etretinate, systemic corticosteroids, and biologics recommended by previous studies. Although administration of high-dose vitamin A was described in a previous textbook of dermatology, details about the lower limits and treatment periods were not provided. We presented a pediatric case of PRP that was successfully controlled with minimum dosage of systemic vitamin A in the literature. Before and 14 days after beginning the therapy, both vitamin A levels of peripheral blood were within the normal range. We considered that the clinical efficacy may not be due to a supplementary effect of vitamin A, but to a pharmacological action because serum vitamin A was within the normal limits during the therapy.

Pityriasis rubra pilaris: algorithms for diagnosis and treatment

“…4,5 Meanwhile, the understanding is that PRP is not a consequence of vitamin A deficiency, but rather it is responsive to alitretinoin, isotretinoin etretinate, and vitamin A. [6][7][8] Accepted triggers of PRP are viral or bacterial infections. [9][10][11][12][13][14] The successful treatment of PRP with antiretroviral drugs in HIV-positive patients can be especially placed as a standard therapeutic measure.…”

“…In the past, vitamin A deficiency was postulated as one of the causes of PRP . Meanwhile, the understanding is that PRP is not a consequence of vitamin A deficiency, but rather it is responsive to alitretinoin, isotretinoin etretinate, and vitamin A . Accepted triggers of PRP are viral or bacterial infections .…”

Successful treatment of juvenile pityriasis rubra pilaris with ustekinumab in a 7-year-old girl

“… 4 There are currently 41 reported cases of PRP in children treated with systemic therapy, 33 of which used vitamin A derivatives. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 Other cases used broad-spectrum immunosuppressant drugs, such as methotrexate or cyclosporine.…”