What is Pityriasis Rubra Pilaris?
Pityriasis rubra pilaris or PRP is a condition where there is a development of reddish, scaly patches on the skin, which cover parts like elbows, knees, palms and soles. In most patients, Pityriasis rubra pilaris lasts only for a week or a few weeks, however, in some cases it can last longer, i.e. up to 6 months. About 2% of the patients have recurrence. The overall prevalence of this condition in the United States has been estimated to be 0.13% in men and 0.14% in women. Pityriasis rubra pilaris primarily occur between the age group of 10 to 35 years.
Is Pityriasis Rubra Pilaris Contagious?
Pityriasis rubra pilaris is not a contagious disease, nor it is an infectious disease. So, it cannot be acquired via close contact with a person afflicted with the disease.
Types Of Pityriasis Rubra Pilaris:
There are six types of Pityriasis rubra pilaris.
Classical Adult Onset Pityriasis Rubra Pilaris:
This is the most common type of Pityriasis rubra pilaris and occurs in adulthood. The symptoms usually go away in a few years. However, in some cases the symptoms return later
Atypical Adult Onset Pityriasis Rubra Pilaris:
Like the classical adult onset Pityriasis rubra pilaris, Atypical adult onset Pityriasis rubra pilaris also begins in adulthood. However, in this case the symptoms may last more than 20 years.
Classical Juvenile Onset Pityriasis Rubra Pilaris:
Classical juvenile onset Pityriasis rubra pilaris begins in childhood. The symptoms usually go away within one year; however, they may come back later.
Circumscribed Juvenile Onset Pityriasis Rubra Pilaris:
Circumscribed juvenile onset Pityriasis rubra pilaris starts before puberty. This type of Pityriasis rubra pilaris affects the palms of children’s hands, soles of their feet, knees and elbows. The symptoms here may go away during the teenage years.
Atypical Juvenile Onset Pityriasis Rubra Pilaris:
This type of Pityriasis rubra pilaris is sometimes inherited. It means, it is passed on through the family. It can be present at birth or may develop during early childhood. The symptoms generally last for life.
HIV-Associated Pityriasis Rubra Pilaris:
One more type of Pityriasis rubra pilaris is HIV-associated Pityriasis Rubra Pilaris. It is linked with HIV and is very difficult to treat.
Causes Of Pityriasis Rubra Pilaris:
The exact cause of Pityriasis Rubra Pilaris is still unclear and the onset of the condition is often sporadic. There are some cases where Pityriasis rubra pilaris exists as an inherited disease; however, most cases are not. The disease can be partially inherited, where there is a 50% chance that an offspring can get the disease from their parents, who carried the defective gene. However, it must be mentioned that not all children with parents carrying the defective gene, suffer from Pityriasis rubra pilaris.
Classical adult onset Pityriasis Rubra Pilaris may be linked with underlying skin cancer. It is essential for you to see your doctor and check for skin cancer, if you have classical onset PRP.
According to the Genetic and Rare Disease Information Center, Pityriasis rubra pilaris may also be linked to an immune system response.
As per the National Organization For Rare Disorders, Pityriasis Rubra Pilaris may also be due to a problem in the way our body processes Vitamin A. However, further research is required to figure out if it is true.
Symptoms Of Pityriasis Rubra Pilaris:
Pityriasis rubra pilaris is characterized by the development of patches on the skin covering either the entire skin surface or part of the body, such as the elbows, knees, palms and soles. The developed patches have well-defined borders and have reddish-orange or reddish-brown discoloration with about pinhead in size.
There is also severe flaking of the skin that accompanies with itchiness and thickening bumps that grows around the hair follicles. There may also be changes in the nails. A yellowish-brown discoloration in the distal end of the nails may occur, including nail thickening and longitudinal ridging. In case of Pityriasis rubra pilaris, there may also be changes or problems with vision or the affected may also complain of a blurry vision.
Apart from this, the mucus membrane also exhibits changes because of Pityriasis rubra pilaris. The patient may have irritation and pain in and around the mouth.
Stages Of Pityriasis Rubra Pilaris:
Stage 1: Initial Stage With Pre-Onset Signs
Here there are mild signs of dandruff and crusty scalp and also limited red patches or scaling of the skin. Slowly, depending on the advancement of inflammation, the signs may progress and the patches on skin begins to turn red, pink or orange-red scaly patches which are usually scaly. Patches most often occur on the knees, elbow, hands, feet and ankles. Apart from this, the skin on soles and palms also become red or waxy and thickened with a classic orange hue. The scaly patches may eventually spread all over the body. Moreover, there may be a development of cracks or fissure within the thickened skin and they can be painful. The nails may also become thickened, ridged, discolored and may even shed. Due to the disorder itself, hair may also shed.
Stage 2: Acute Stage And Its Signs:
In acute stage of Pityriasis rubra pilaris, there are signs such as dry, red and flaking skin, swollen legs and feet, and cracked and bleeding feet and hands. There may also be a serious issue related to impaired mobility, vision and eyes. Pruritus, disturbance in sleep and pain are some of the common signs at this stage of the PRP. This stage poses the greatest challenge to the body, mind and spirit and can last anywhere from less than one month or many months longer.
Stage 3: Management Stage and Signs
After the acute stage, the management stage comes where the affected person takes on a new focus, i.e. mitigating and managing the signs and symptoms of the condition. Here, there may be joint pain, clogged ears and disabilities too. For everyone, their daily routine associated with medication, moisturizing and dealing with the challenges of the body, mind and spirit of person suffering from Pityriasis rubra pilaris, cannot be ignored.
Treatments Of Pityriasis Rubra Pilaris:
It must be mentioned that there is no cure for pityriasis rubra pilaris currently. However, treatments can relieve the severity of the symptoms. Below are some of the treatments that might be prescribed by your doctor if you have Pityriasis Rubra Pilaris.
Medical Treatments For Pityriasis Rubra Pilaris:
Oral Retinoids: Oral retinoids, such as, Isotretinoin or acitretin, are prescribed for getting rid of symptoms in Pityriasis rubra pilaris. These are the derivatives of vitamin A that slow down the growth and shedding of skin cells.
Oral Vitamin A: This may be beneficial in some individuals suffering from pityriasis rubra pilaris, however, only in very high doses. Retinoids are more effective and more commonly used than vitamin A.
Topical Creams: Topical creams containing urea or lactic acid, are used to reduce the severity of the symptoms in pityriasis rubra pilaris. These creams go directly on your skin.
Methotrexate: This is an oral drug that may be prescribed in case retinoids do not work in the treatment of pityriasis rubra pilaris.
Immunosuppressants: Immunosuppresants are oral medications that suppress the immune system. Cyclosporine and Azatioprine are some of the immunosuppressants.
Biologics: Biologics are injectable or Intravenous or IV medications that affect your immune system. They include drugs etanercept, adalimumab and infliximab.
Home Remedies For Pityriasis Rubra Pilaris
The primary aim in treating Pityriasis Rubra Pilaris is to reduce the severity of symptoms, so that the affected person feels more comfortable. Some of the home remedies that can be tried to get rid of Pityriasis rubra pilaris include the following.
Creams And Oils: Emmolient creams are known to be useful in reducing the dryness. Vegetable oils are effective emollients. You can use coconut oil as a home remedy to lubricate the dry scaly lesions, which may cause cracks and fissures. You need to apply it over the surface at night so that there is a complete absorption.
Ointments: Steroid ointments and creams are also known to be effective in relieving the symptoms of Pityriasis rubra pilaris. However, they should be used only after consulting your doctor.
Diet: It is essential for you to consume foods rich in vitamin A. Fish and other sea foods, that are loaded with high amount of Vitamin A, must be taken. Your doctor may also prescribe you with some vitamin A supplements.
Sunlight: Exposure to ultraviolet rays of the sun along with the oral medications may be useful home remedy in reducing the severity of the condition.
Complications Of Pityriasis Rubra Pilaris:
There are some complications of Pityriasis Rubra pilaris; and they include the secondary conditions, symptoms, or other disorders that are caused by pityriasis rubra pilaris. Hyperkeratosis or thickening of skin due to excess production of the protein called Keratin is one of the complication. Corns and warts are some of the examples of Hyperkeratosis. One more complication of Pityriasis Rubra Pilaris includes erythema, which is a condition characterized by redness of the skin caused due to congestion of the capillaries.
So, Pityriasis rubra pilaris is a skin condition that might have some complications and require proper treatments and home remedies to get rid of it. It must be noted that the condition cannot be prevented, since the cause and the onset of Pityriasis Rubra Pilaris are still unknown. However, in case you suspect to have Pityriasis rubra pilaris, then do visit your dermatologist and begin the treatment as soon as possible.