SPONTANEOUS IMPROVEMENT IN A PATIENT WITH JUVENILE PITYRIASIS RUBRA PILARIS

Abstract

Pityriasis rubra pilaris (PRP) is a rare and complex dermatosis characterized by erythematous plaques, follicular papules, hyperkeratosis, and scaling. While its precise etiology remains largely unidentified, genetic predisposition, immune-mediated mechanisms, and environmental triggers are implicated in its pathogenesis. 

We present a case of a 3-year-old child with a 1-month history of erythematous macules, initially affecting the hands, feet, perioral, and periocular regions. The lesions were initially recognized by a dermatologist and pediatrician as hand, foot, and mouth disease (HFMD). Two weeks later, the patient developed widespread involvement of 80% of the skin surface, including the face. Considering the evolutionary progression of the clinical changes, a diagnosis of pityriasis rubra pilaris (PRP) was established.  

After 6 weeks of local treatment with corticosteroids and emollients, significant reduction in body surface area (BSA) was observed. The idea of initiating systemic therapy with acitretin was dismissed, given the favorable course of the disease. After 5 months of clinical observation, the patient achieved complete resolution of the skin changes, highlighting the self-limiting nature of the juvenile form. The patient underwent frequent check-ups for 1 year, and no changes or relapses were observed. This case highlights the value of conservative management and vigilant monitoring in achieving long-term resolution and minimizing the need for systemic interventions.