eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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vol. 36
Letter to the Editor

Erythroderma in the course of pityriasis rubra pilaris in a 7-year-old female

Agata D. Kłosowicz
Katarzyna Kaleta
Anna Ryczek
Natalia Juśko
Monika Kapińska-Mrowiecka

Department of Dermatology and Venereology, Stefan Zeromski Municipal Hospital, Krakow, Poland
Adv Dermatol Allergol 2019; XXXVI (4): 501-503
Online publish date: 2019/08/30
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Pityriasis rubra pilaris (PRP) is an uncommon clinically heterogeneous keratinization skin disorder. PRP occurs equally in men and women and has a bimodal age distribution with typical onset during the first and fifth decades [1]. Due to the significant clinical diversity, PRP is classified into six subgroups according to age of onset, distribution, morphologic features, clinical course and human immunodeficiency virus (HIV) infection [1, 2]. The aetiology of the disease remains unknown but several studies have reported its occurrence in the setting of viral infection, trauma, stress, associated autoimmune diseases, malignancies and drugs [3].
We present the case of a 7-year-old patient with type III PRP in which emotional stress appeared to be the most probable triggering factor.
A 7-year-old girl was referred to our institution for a diagnostic evaluation of skin lesions with a 3-month history. The skin lesions clinically appeared as generalised erythroderma. Locally, physical examination revealed diffuse pityriasiform scale of the scalp, confluent areas of erythema on the trunk (Figure 1 C) and follicular hyperkeratotic papules within erythematosquamous plaques with an orange hue distributed on the legs. Patches of normal skin were evident within those sheets of erythema (Figure 1 A). Waxy palmoplantar keratoderma with fissures was observed (Figure 1 B). Skin burning sensation and itching accompanied skin lesions. The patient’s past medical history was notable only for mild xerosis cutis. A review of systems was non-contributory. Family history of psoriasis and atopic diseases was negative. There were no similar previous episodes or recent exposure to drugs or infections. Four months before hospitalisation the patient began primary school. Her mother noted that in that time the patient developed anxiety, aggressiveness and social isolation due to rejection by friends in her class. She tended to refrain from social activities in the presence of peers. The first skin lesions in the form of scaly erythematous patches developed initially over the elbows and knees 4 weeks after the First Day of Class. Despite initial therapy with hydroxyzine and emollients prescribed by her primary care physician, the plaques spread throughout the patient’s face, scalp, torso and limbs. Her hands and feet developed an orange-red appearance with desquamation. She was referred to the Paediatric Dermatology Department where she was clinically diagnosed with...

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