Case and Research Letters
Acute Postinfection Pityriasis Rubra Pilaris: Excellent Response to Emollients and Topical Corticosteroids
Pitiriasis rubra pilaris aguda postinfecciosa: gran respuesta a emolientes y a corticosteroides tópicos
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On the left, hematoxylin–eosin (H-E) staining with images from smallest to largest magnification under an optical microscope, showing the histological characteristics of cutaneous follicle center B-cell lymphoma: lymphocyte infiltrate located in the middle and deep dermis with a mixed (nodular/diffuse) growth pattern and presence of cells of centrocytic and centroblastic appearance. On the right, immune-staining panel compatible with primary cutaneous center follicle lymphoma. The panel shows positive staining for CD10, CD20, Bcl-2, and Bcl-6 (hematoxylin–eosin, x2, x4, x10, x20, x20; IHQ, x2, x2, x2, x4).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Sarriugarte Aldecoa-Otalora, J. Mitxelena Eceiza, A. Córdoba Iturriagagoitia, M.C. Viguria Alegría" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Sarriugarte Aldecoa-Otalora" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Mitxelena Eceiza" ] 2 => array:2 [ "nombre" => "A." 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Garayar Cantero, E. Manrique-Silva, E. Godoy-Gijón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Garayar Cantero" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Manrique-Silva" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Godoy-Gijón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731021000016" "doi" => "10.1016/j.ad.2019.07.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021000016?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001633?idApp=UINPBA000044" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001633/v1_202107020822/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Acute Postinfection Pityriasis Rubra Pilaris: Excellent Response to Emollients and Topical Corticosteroids" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "667" "paginaFinal" => "668" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.S. Zegpi-Trueba, L. Navajas-Galimany, S. González, C. Ramírez-Cornejo" "autores" => array:4 [ 0 => array:3 [ "nombre" => "M.S." "apellidos" => "Zegpi-Trueba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Navajas-Galimany" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "C." "apellidos" => "Ramírez-Cornejo" "email" => array:1 [ 0 => "caramir3@uc.cl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatopatología SG, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pitiriasis rubra pilaris aguda postinfecciosa: gran respuesta a emolientes y a corticosteroides tópicos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3097 "Ancho" => 1674 "Tamanyo" => 325556 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Initial clinical picture: multiple salmon-pink plaques on the trunk and both arms. B, Complete response after 4 weeks of topical corticosteroid treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 9-month-old boy was seen for a localized skin rash on the abdomen and extremities that had spread rapidly over the preceding 2 months. The patient had no other associated symptoms. His clinical history included multiple episodes of pyelectasis that had been treated with prophylactic antibiotics (cefadroxil) up to 5 months of age. Before the skin lesions appeared, the patient had undergone antibiotic and corticosteroid treatment for multiple viral and bacterial infections of the upper respiratory tract. Physical examination revealed confluent salmon-pink papules and plaques on the trunk and extremities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), with islands of healthy skin on both legs. Biopsies of the lesions showed acanthosis, hypergranulosis, orthokeratosis, parakeratosis, and mild superficial infiltrate, findings consistent with pityriasis rubra pilaris (PRP) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient was treated for 1 month with topical 0.05% triamcinolone acetonide cream, which resulted in complete resolution of the lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Due to the patient’s clinical history of recent respiratory infections, the early resolution of the skin lesions, and the histological findings, a diagnosis of acute postinfectious PRP was proposed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">PRP is a skin disease that rarely affects children. In 1980, Griffiths proposed a classification system that divided PRP into 5 categories according to clinical and epidemiological features and clinical course. Variants that occur in children include classical juvenile (type III), circumscribed juvenile (type IV), and atypical juvenile (type V) PRP.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 1983, Larregue described a new variant called postinfectious PRP, based on a case series of children aged over 1 year with a history of one or more recent respiratory infections. These patients presented skin lesions that resembled those of juvenile classic PRP, but with acute onset, a good prognosis, and a low tendency to recur.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> While skin lesions in postinfectious PRP may resemble other superantigen-mediated dermatoses, their histology and treatment are distinct.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Few studies have investigated treatment efficacy in children with PRP. In patients with types III and IV, the best results have been achieved with systemic retinoids.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The use of oral vitamin A is controversial, as a good response has been observed only in a few patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Ferrándiz-Pulido et al published a series of 4 children diagnosed with postinfectious PRP, 3 of whom were treated with topical corticosteroids. Only one patient responded favorably to the 5-week treatment. The others required acitretin treatment to achieve a clinical response. The fourth patient underwent a 3-week course of topical emollients and salicylic acid, with a complete response.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our patient, treatment with topical emollients and triamcinolone acetonide proved effective, although we cannot rule out the possibility of spontaneous resolution given the potential postinfectious etiology of the condition.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zegpi-Trueba MS, Navajas-Galimany L, González S, Ramírez-Cornejo C. Pitiriasis rubra pilaris aguda postinfecciosa: gran respuesta a emolientes y a corticosteroides tópicos. Actas Dermosifiliogr. 2021;112:667–668.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3097 "Ancho" => 1674 "Tamanyo" => 325556 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Initial clinical picture: multiple salmon-pink plaques on the trunk and both arms. B, Complete response after 4 weeks of topical corticosteroid treatment.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1183 "Ancho" => 1674 "Tamanyo" => 301247 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Orthokeratosis alternating with foci of parakeratosis (hemoxylin eosin, original magnification ×40). The epidermis shows regular acanthosis and psoriasiform hyperplasia, and scarce inflammatory infiltrate is evident in the dermis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pityriasis rubra pilaris: a review of diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Klein" 1 => "M. Landthaler" 2 => "S. Karrer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11530070-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol." "fecha" => "2010" "volumen" => "11" "paginaInicial" => "157" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20184391" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute postinfectious pityriasis rubra pilaris: a superantigen-mediated dermatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Ferrándiz-Pulido" 1 => "R. Bartralot" 2 => "P. Bassas" 3 => "D. Bodet" 4 => "T. Repiso" 5 => "G. Aparicio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0001-7310(09)72284-7" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." 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"fecha" => "2015" "volumen" => "42" "paginaInicial" => "1210" "paginaFinal" => "1211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26387659" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001645/v1_202107020822/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000007/v1_202107020822/S1578219021001645/v1_202107020822/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001645?idApp=UINPBA000044" ]
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