Q. My husband has had pityriasis rubra pilaris for about three years. He has taken two medications all this time, but gets bad reactions from them. His skin is raw from the constant peeling and very itchy. Do you know of something we can do for this condition?
-- H.S., Port Orange, Fla.
A. Pityriasis is a name originally given to a group of inflammatory skin diseases characterized by red, scaly skin. The various forms of pityriasis are so different -- in duration, symptoms, severity and treatment -- that now the term is always accompanied by further description.
Early symptoms of pityriasis rubra pilaris, a chronic (long-term) inflammatory skin disease, include red, scaly patches with varying degrees of itching; tiny, sharp-pointed reddish-brown bumps, topped by central horny plugs; and/or increased growth of the horny layer of the skin of the palms and soles, a condition known as keratoderma.
The disease progresses to a generalized reddened skin and increased keratoderma, which can often be disabling.
The cause is unknown, but there is evidence of an inherited aspect to this condition. However, the condition can be acquired as well as inherited and is seen in both adults and children.
Diagnosis is usually based on the symptoms, and is confirmed by a biochemical analysis of skin biopsy specimens. Were specimens taken of your husband's skin and analyzed? Many inflammatory skin diseases have symptoms similar to pityriasis rubra pilaris.
Treatment is based on two forms of drugs, retinoids and antitumor drugs. Use of retinoids is said to have revolutionized skin disease treatment in the past 20 years.
Etretinate and isotretinon are two well-known retinoids that are effective in controlling pityriasis rubra pilaris. Isotretinon is best known by its brand name, Accutane, and is usually thought of as the treatment for severe cases of acne.
Isotretinon works on pityriasis rubra pilaris by inhibiting sebaceous gland function and growth of the horny layer of skin. It is serious medicine with side effects and should not be taken by women of childbearing age.
Methotrexate is the antitumor drug of choice for your husband's condition. It is also used successfully in the treatment of severe psoriasis. The term "antitumor" is a little misleading -- this group of drugs is more precisely called antineoplastic drugs. Neoplastic means "new tissue."
If your husband's condition has been verified as pityriasis rubra pilaris, all I can recommend is for him to stay in touch with his doctor to relate changes in his condition and to check for new treatment options, especially since the medications he is now taking are causing significant problems. Also, have the doctor recommend something for his itching, such as a topical steroid, antihistamine or both.
Write to Allen Douma in care of kALIVE, 1777 N.E. Loop 410, San Antonio, Texas 78217, or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.