acyclovir and Pityriasis-Rubra-Pilaris

The clinical and histopathological diagnosis of pityriasis rubra pilaris (PRP) can be difficult because clinical findings are often subtle in early stages, and microscopic findings can overlap with those of other skin diseases. Focal acantholytic dyskeratosis (FAD) can rarely be seen in PRP and can mimic Darier's disease, Grover's disease or other disorders characterized by these histopathologic features. Kaposi's varicelliform eruption is a widespread infection due to herpes simplex virus (HSV) types 1 and 2, coxsackievirus A16 or vaccinia virus, occurring in a preexisting dermatosis; only one case has been reported in PRP. We report a patient with PRP whose biopsies showed both herpes simplex infection and FAD. A complete understanding of the mechanism behind this eruption evolved gradually, aided in great measure by the histopathologic findings.

Topics: Acantholysis; Acyclovir; Aged; Antiviral Agents; Darier Disease; Diagnosis, Differential; Herpes Simplex; Humans; Ichthyosis; Kaposi Varicelliform Eruption; Male; Methotrexate; Pityriasis Rubra Pilaris; Valacyclovir; Valine

To report a case of bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis resulting in corneal perforation in a patient with pityriasis rubra pilaris.. Case report.. A 77-year-old female with pityriasis rubra pilaris was referred for a perforated corneal ulcer of the left eye. Cultures were positive in both eyes for Herpes simplex and in the left eye for Pseudomonas fluorescens and Staphylococcus aureus A microbiological cure was obtained with a combination of tectonic keratoplasty, fortified topical antibiotics, and systemic acyclovir.. Pityriasis rubra pilaris is a rare, inflammatory dermatologic disease that may predispose patients to bilateral Herpes simplex keratitis, secondary bacterial superinfection, and a tendency toward rapid stromal ulceration with risk of perforation.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cefazolin; Ceftazidime; Corneal Transplantation; Corneal Ulcer; Female; Humans; Keratitis; Keratitis, Herpetic; Pityriasis Rubra Pilaris; Pseudomonas fluorescens; Pseudomonas Infections; Staphylococcal Infections