Systemic therapies of pityriasis rubra pilaris: a systematic review.

Abstract

Pityriasis rubra pilaris (PRP) is a rare papulosquamous disorder. Treatment is challenging; the armamentarium consists of topical corticosteroids, phototherapy, classic systemic treatments such as retinoids or immunosuppressive drugs, and most recently biologicals. However, the relative effectiveness of therapies is unclear. Our objective was to review the published literature on systemic treatment of PRP. A systematic review was conducted on PubMed and the Cochrane Library up to 5 September 2017. Studies evaluating any systemic treatments of PRP (except for historical treatments) were included. Overall, 182 studies met the predefined inclusion criteria, and reported on 475 patients and 652 courses of treatment. 42.0 % (225/514) of all patients treated with retinoids achieved an excellent response (isotretinoin: 61.1 % [102/167], etretinate: 47 % [54/115], and acitretin: 24.7 % [43/174]) compared to an excellent response rate of 33.1 % (53/160) with methotrexate. Therapy with biologicals was successful in 51.0 % of patients (71/133) (ustekinumab: 62.5 % [10/16], infliximab: 57.1 % [28/49], etanercept: 53.3 % [16/30], and adalimumab: 46.4 % [13/28]). This review balances effectiveness, side effects, experience, and drug costs in order to suggest a treatment regimen starting with isotretinoin as first-line, methotrexate as second-line and biologicals as third-line treatment for this difficult-to-treat dermatosis.

• Authors: Christian Kromer, Robert Sabat, Daniel Celis, Rotraut Mössner
• Journal: Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG (J Dtsch Dermatol Ges) Vol. 17 Issue 3 Pg. 243-259 (Mar 2019) ISSN: 1610-0387 [Electronic] Germany
• PMID: 30520557 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Chemical References

• Biological Products
• Dermatologic Agents

Topics

• Adolescent
• Adult
• Age Distribution
• Biological Products (therapeutic use)
• Child
• Dermatologic Agents (therapeutic use)
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Pityriasis Rubra Pilaris (drug therapy)
• Treatment Outcome
• Young Adult