tacrolimus and Pityriasis-Rubra-Pilaris

Incidents of new-onset vitiligo attributed to infliximab therapy for rheumatoid arthritis and ulcerative colitis have been reported. Reported cases share a common theme in that symptoms manifested in close proximity to the initiation or significant dose increase of the medication. This case describes the presentation of infliximab-induced vitiligo in a patient using it for long-term treatment of stable pityriasis rubra pilaris. The patient was initiated and titrated to a stable dose of infliximab totaling 27 months' duration. He was able to achieve near-complete resolution of symptoms before developing depigmented patches consistent with vitiligo. Infliximab was discontinued. Tacrolimus 0.1% ointment and narrow-band ultraviolet B light successfully repigmented the patches. The association of discontinuing infliximab and resolution of vitiligo suggests infliximab had a role in this case. Though the mechanism of involvement is undetermined, infliximab may have induced an autoimmune process by paradoxically activating lymphocytes. Alternatively, infliximab antibodies may have led to the process by disrupting the normal balance of cytokines.

Topics: Antibodies, Monoclonal; Antirheumatic Agents; Arthritis, Rheumatoid; Diabetes Mellitus, Type 2; Gout; Humans; Immunosuppressive Agents; Infliximab; Male; Middle Aged; Pityriasis Rubra Pilaris; Tacrolimus; Ultraviolet Therapy; Vitiligo

Pityriasis rubra pillaris is an uncommon idiopathic dermatosis considered both a keratinization and an inflammatory disorder. Treatment is largely based on the information presented in case reports. We report the case of a young man with pityriasis rubra pillaris limited to the scalp and face, which cleared completely after application of pimecrolimus 1% cream for 2 weeks.

Topics: Acitretin; Administration, Topical; Adult; Dermatologic Agents; Face; Humans; Keratolytic Agents; Male; Ointments; Pityriasis Rubra Pilaris; Scalp; Skin; Tacrolimus

Pityriasis rubra pilaris is a chronic, papulosquamous dermatosis of unclear etiology. The case of a 61-year-old man with pityriasis rubra pilaris is presented. The clinical forms, histopathologic features, and treatment options of pityriasis rubra pilaris are reviewed.

Topics: Acitretin; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Keratolytic Agents; Male; Middle Aged; Ointments; Pityriasis Rubra Pilaris; Tacrolimus