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Pityriasis rubra pilaris (PRP), a disorder of epidermal proliferation and altered keratinization, typically first appears as a scaly, erythematous patch on the upper portion of the body. Its initial appearance is nonspecific and may be confused with other common dermatoses. Subtle clinical findings and histologic changes in the early stage of PRP are helpful in the early diagnosis of this condition. We describe two cases to illustrate the initial manifestations of PRP and review the literature, emphasizing its early presentation and treatment.

Tinea capitis has a wide variety of clinical presentations in adolescents and adults. However, the occurrence of fingerlike projections in the scalp has not been previously described. A 14-year-old girl presented with a one-year history of a painful scalp mass. Debridement of this mass revealed slender papillomatous growths resembling those seen in elephantiasis nostras verrucosa. A fungal culture grew Trichophyton mentagrophytes. We describe the first case of this unusual clinical variant of tinea capitis and hypothesize on its pathophysiological basis.