Severe, Disfiguring, Pityriasis Rubra Pilaris in a Woman in the Dominican Republic: Histopathologic Diagnosis and Response to Antiretroviral Therapy

J Int Assoc Provid AIDS Care. Jan-Feb 2016;15(1):11-4. doi: 10.1177/2325957415614649. Epub 2015 Oct 29.

Abstract

Pityriasis rubra pilaris (PRP) is a poorly understood dermatologic condition usually accompanied by keratoderma and intense erythroderma with islands of unaffected skin. The PRP categories include HIV-associated PRP VI. A 23-year-old HIV-infected, dark-skinned woman in the Dominican Republic developed an extremely severe, disfiguring process characterized first by a dry scaly rash involving her face, trunk, and extremities with hyperpigmentation and islands of spared skin and minimal erythroderma, followed by alopecia and development of a thick horny layer on the scalp and face. The condition, histologically proven to be PRP, was accompanied by fever, wasting, and decline in CD4 count. Initiation of combination antiretroviral therapy (cART) was followed by rapid and sustained resolution of PRP. Nine years after ART initiation, she remains well, with viral suppression and immune recovery, without PRP recurrence but with sparse hair regrowth and facial scarring. In some dark-skinned patients, severe PRP may not feature characteristic erythroderma but will respond to combination ART.

Keywords: AIDS; Dominican Republic; HIV; antiretroviral therapy; pityriasis rubra pilaris.

Publication types

  • Case Reports

MeSH terms

  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Dominican Republic
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / immunology
  • Humans
  • Pityriasis Rubra Pilaris / diagnosis
  • Pityriasis Rubra Pilaris / etiology*
  • Pityriasis Rubra Pilaris / immunology
  • Young Adult

Substances

  • Anti-HIV Agents