Atypical adult onset pityriasis rubra pilaris: a rare chronic form of pityriasis rubra pilaris

<p class="abstract">Pityriasis rubra pilaris (PRP) are a group of clinically similar papulo squamous dermatoses which present with erythematous, hyperkeratotic perifollicular papules tend to coalesce form plaques and may progress erythroderma. We report case 46-year-old female patient who came chief complaint itching burning sensation scaly patches on extremities since one year. On dermatological examination well demarcated follicular plugging peripheral rim erythema were seen over extensor flexor aspects elbows, knees, thighs, legs, dorsum foot gluteal region. Diffuse palmoplantar keratoderma, diffuse scaling the scalp, thickened brownish black nails seen. histopathology alternating layers orthokeratosis parakeratosis, acanthosis broad rete ridge, perivascular lymphocytic infiltration in upper dermis was seen, suggestive PRP. Patient responded oral acitretin 25 mg once daily combined methotrexate 10 weekly along topical emollients corticosteroids after 6 weeks treatment.</p>