Paraneoplastic pityriasis rubra pilaris in association with prostate carcinoma: A case report and literature review

Abstract

Pityriasis rubra pilaris (PRP) is a chronic papulosquamous disorder of unknown etiology, characterized by reddish orange scaly plaques, islands of sparing, palmoplantar keratoderma, and keratotic follicular papules. The disease can be acquired or inherited, being divided into 5 categories: classic adult type, atypical adult type, classic juvenile type, circumscribed juvenile type, and atypical juvenile type. More recently, an HIV-associated type has been added to this classification. The cases of PRP associated with malignancy are unusual. We present a case of a 58-year-old man, with the typical clinical aspect of PRP with a four-month onset of the disease. The histopathological and dermatoscopical findings confirmed the PRP diagnosis. The routine laboratory results were in normal limits, except the number of eosinophils, which was elevated and the number of lymphocytes, which was lower. After a thorough examination within a hematological consultation, the cause of hypereosinophilia remained unknown. An imagistic examination was performed and a prostate hypertrophy was noted. The prostate-specific antigen (PSA) level was found to be increased. The urologic consultation based on clinical, imagistic and microscopic features diagnosed an early stage prostate carcinoma. The conclusion was a paraneoplastic PRP in association with prostate carcinoma. The search in international databases revealed twelve published cases regarding the association of PRP with malignancies. The presented case represents a rare coexistence of PRP with malignancy, particularly with prostate carcinoma, and indicates that PRP can occur as paraneoplastic dermatosis, heralding a malignancy. This case is the first one to present PRP associated with prostate carcinoma. Nonetheless, in the authors' opinion, PRP can be considered a paraneoplastic syndrome; therefore, tumor screening is mandatory in cases presenting this disease.

Cutaneous adverse reactions in a lung cancer patient treated with pembrolizumab: A case report

“…The latest literature states that cases with mild cutaneous adverse reactions (such as lichenoid reactions, granulomatous skin reactions), as in our patient's case, can receive treatment with topical corticosteroids at low doses, moisturizing ointments or oral antihistamines (27,28,30,31). Some patients who developed cutaneous adverse reactions such as vitiligo registered skin repigmentation, not as proof for skin lesion treatment response, but as proof for cancer (melanoma) progression.…”

“…The latest literature states that cases with mild cutaneous adverse reactions (such as lichenoid reactions, granulomatous skin reactions), as in our patient's case, can receive treatment with topical corticosteroids at low doses, moisturizing ointments or oral antihistamines ( 27 , 28 , 30 , 31 ).…”

“…Therapeutic management in these cases included topical steroids and/or vitamin D analogues, systemic retinoids, or even methotrexate. Cases of pityriasis rubra pilaris have also been reported after pembrolizumab therapy (some also as a paraneoplastic syndrome), these patients being successfully treated with acitretin and topical steroids (27)(28)(29)(30)(31).…”

Keratosis pilaris atrophicans faciei: An observational, descriptive, retrospective clinical study

“…Furthermore, Wang and Orlow summarized KP associations with various neuro-cardio-facial-cutaneous syndromes, ectodermal dysplasias, and neuro developmental disorders, as well as KP-induced drug reactions (11). Differential diagnosis includes a large spectrum of diseases that affect children and adolescents, and which progresses with facial erythema, from habitual erythema, rosacea, atopic dermatitis, comedonal acne, to KP subtypes, including keratosis pilaris rubra faciei, erythromelanosis follicularis faciei et colli, atrophoderma vermiculatum, Darier-White disease, and pityriasis folliculorum (12)(13)(14)). An early diagnosis allows for a targeted treatment option.…”

[Editorial] Highlights of the 3rd conference of the Romanian Association of Immuno‑Dermatology and the 37th conference of the Romanian Society of Immunology held in Bucharest between September 19 and 22, 2019

“…Fekete et al (13) reported, in a case presentation, the association between paraneoplastic pityriasis rubra pilaris and prostate carcinoma, concluding that PRP can be considered a paraneoplastic syndrome; therefore, tumor screening is mandatory in cases presenting this disease.…”