Pityriasis rubra pilaris
Pityriasis rubra pilaris (PRP) is a rare skin disorder that causes inflammation and scaling (exfoliation) of the skin.
PRP; Pityriasis pilaris; Lichen ruber acuminatus; Devergie disease
There are several subtypes of PRP. The cause is unknown, although genetic factors and an abnormal immune response may be involved. One subtype is associated with HIV/AIDS.
PRP is a chronic skin condition in which orange or salmon-colored scaly patches with thick skin develop on the hands and feet.
The scaly areas may cover much of the body. Small islands of normal skin (called islands of sparing) are seen within the areas of the scaly skin. The scaly areas may be itchy. There may be changes in the nails.
PRP can be severe. Although it's not life threatening, PRP can greatly reduce quality of life and limit activities of daily living.
Exams and Tests
The health care provider will examine your skin. Diagnosis is usually made by presence of the unique skin lesions. (A lesion is an abnormal area on the skin). The provider may take samples (biopsies) of the affected skin to confirm the diagnosis and rule out conditions that may look like PRP.
Topical creams containing urea, lactic acid, retinoids, and steroids may help. More commonly, treatment includes pills taken by mouth such as isotretinoin, acitretin, or methotrexate. Exposure to ultraviolet light (light therapy) may also help. Medicines that affect the body's immune system are currently being studied and may be effective for PRP.
This resource can provide more information on PRP:
- National Organization for Rare Disorders -- rarediseases.org/rare-diseases/pityriasis-rubra-pilaris
When to Contact a Medical Professional
Call your provider if you develop symptoms of PRP. Also call if you have the disorder and symptoms worsen.
James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Pityriasis rosea, pityriasis rubra pilaris, and other papulosquamous and hyperkeratotic diseases. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 11.
Patterson JW. Disorders of pigmentation. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 10.
Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.