THERAPEUTIC HOTLINE: Treatment of pityriasis rubra pilaris with etanercept

Pityriasis rubra pilaris (PRP) or Devergie's disease is a chronic and rare papulosquamous disorder of unknown etiology characterized by reddish orange scaly plaques, palmoplantar keratoderma, and keratotic follicular papules. The present authors report a case of a 30-year-old woman with clinical and histologic signs of PRP (type I adult onset, Griffith's classification). After a few unsuccessful treatments, the present authors chose to start etanercept. Total clearing of the lesions was achieved 5 months after starting the drug. Etanercept is a TNF-α inhibitor, and today it is largely used in the treatment of several dermatological diseases through blockage of the inflammatory cytokine. The true mechanism of action in PRP remains to be explained; however, the favorable results in our case raise new questions about TNF-α's role in PRP and suggest a therapeutic alternative for resistant cases to classic treatments. To date, there are only three case reports of PRP treated with etanercept in the literature.