Ulianskaite Gintare, Timinskaite Fausta, Raudonis Tadas
Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513, Vilnius, Lithuania.
Vilnius University, Faculty of Medicine, LT-03101, Vilnius, Lithuania.
Heliyon. 2024 Jun 27;10(13):e33750. doi: 10.1016/j.heliyon.2024.e33750. eCollection 2024 Jul 15.
A 62-year-old woman presented to our hospital with erythroderma affecting 100 % of body surface area, skin scaling and a body temperature of 37.3 C. The lesions initially appeared on her scalp 6 months prior, then psoriasis was diagnosed. Topical corticosteroids were prescribed, which were ineffective. After 2 months the rash spread to the rest of the body, accompanied by nail changes and hair loss. The patient was subsequently admitted to the local hospital, where following clinical evaluation, oral methotrexate 10 mg once weekly was initiated for 6 weeks. Despite the administered treatment the patient's health and skin condition deteriorated, manifesting with an appearance of new lesions. By the time of admission to our hospital erythroderma affecting 100 % of body surface area covered with wide skin scales and punched-out erosions on the torso, lower eyelid ectropion, loss of scalp hair and thickened yellow nail plates were observed. Skin biopsy revealed histological changes consistent with pityriasis rubra pilaris diagnosis. Polymerase chain reaction test from erosions confirmed the presence of herpes simplex virus 1/2 and culture results identified methicillin-resistant Staphylococcus aureus. Given the considerations of pityriasis rubra pilaris, hematologic disorders and paraneoplastic syndrome, a comprehensive work-up for haematological and oncological disorders was conducted, which yielded no significant findings. The patient was treated with intravenous corticosteroids, antibiotics, and antiviral drugs. Isotretinoin was initiated following the histological confirmation of pityriasis rubra pilaris. By the time of discharge, the patient's condition improved. During a follow-up visit 43 weeks after the initiation of isotretinoin, the skin was almost clear. The described case highlights the rare possibility of developing Kaposi's varicelliform eruption in patients with pityriasis rubra pilaris and demonstrates that isotretinoin is a safe and effective treatment option for this condition.
一名62岁女性因全身100%体表面积出现红皮病、皮肤脱屑且体温为37.3摄氏度前来我院就诊。皮损最初于6个月前出现在她的头皮上，随后被诊断为银屑病。曾开具外用糖皮质激素，但无效。2个月后皮疹蔓延至身体其他部位，伴有指甲改变和脱发。患者随后入住当地医院，经临床评估后，开始每周一次口服10毫克甲氨蝶呤，共6周。尽管进行了治疗，患者的健康状况和皮肤情况仍恶化，出现了新的皮损。入院时，观察到全身100%体表面积出现红皮病，覆盖着广泛的皮肤鳞屑，躯干有穿凿性糜烂，下眼睑外翻，头皮脱发，指甲板增厚变黄。皮肤活检显示组织学改变符合毛发红糠疹的诊断。糜烂部位的聚合酶链反应检测证实存在单纯疱疹病毒1/2型，培养结果鉴定出耐甲氧西林金黄色葡萄球菌。鉴于考虑到毛发红糠疹、血液系统疾病和副肿瘤综合征，对血液系统和肿瘤性疾病进行了全面检查，未发现明显异常。患者接受了静脉注射糖皮质激素、抗生素和抗病毒药物治疗。在组织学确诊毛发红糠疹后开始使用异维A酸。出院时，患者病情有所改善。在开始使用异维A酸43周后的随访中，皮肤几乎恢复正常。该病例强调了毛发红糠疹患者发生卡波西水痘样疹的罕见可能性，并表明异维A酸是治疗这种疾病的一种安全有效的选择。
