More than a rash: skin disease and quality of life.

PRP may be underdiagnosed because it has many mimics, the most important of which is psoriasis. The cause is unknown, but genetic and autoimmune components are likely. Although PRP is self-limited in many cases, the disease is highly variable and impairs quality of life. R.S. approached me about treatment. Should he try acitretin (Soriatane), a systemic retinoid that may hasten clearance? R.S. is a 62-year-old long-distance runner, so I was concerned about fatigue as one of many adverse effects of oral retinoids. He had also been self-insured, so a course of treatment would have cost several thousand dollars. Even with the Affordable Care Act, these expensive medications would not have been covered. Our decision to let the disease run its course has so far been vindicated by noticeable improvements in the past several months.