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Pityriasis rubra pilaris (PRP) skin disease

Discussion in 'General Issues and Discussion Forum' started by ALMD, Jun 11, 2018.

  1. ALMD

    ALMD Welcome New Poster

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    Hello all,
    This awful skin disease is affecting a relative of mine terribly.
    The fissures cover the surfaces of both feet. He also wears compression stockings.
    We have had limited success with hydrocolloid dressings, a colleague has recommended Healan Tape so we will order this.
    Just wondering if anyone else has and advice, he is struggling to walk and therefore struggling to work.
    There are plaques of skin lifting revealing raw skin beneath.
    He is about to start Methotrexate under Dermatology.
    Any advice gratefully received.
    A :)
    (Sadly I cannot upload the photo as it is too large but Google has images)
  2. blinda

    blinda MVP

    Sounds like your relative is really struggling with this condition, which has a familial autosomal dominant inheritance pattern, in many cases.

    Unfortunately, there is no known cure. However, symptoms can be alleviated with both short and long-term treatments:

    Short term, the fissures require closing if they are extending to the dermis, to prevent secondary infection. After careful reduction of any hyperkeratotic sharp edges, it might be an idea to apply medical grade adhesive to the cracks as this will provide a barrier against pathogens. This also reduces pain quite remarkably. The adhesive will slough off with skin turnover, allowing the fissures to heal in an occlusive environment – thus it is important to ensure that there are no clinical signs of infection prior to its application. This is also the case with Haelan Tape, as this contains the steroid fludroxycortide so must not be used on an infected wound.

    5-7 days after applying the adhesive, I would recommend they try “Ivans` sock wrap”* for a minimum of 7 nights and thereafter continue with their complete emollient therapy:
    1) Use the emollient as a cleanser (soap substitute) for bathing/showering
    2) Apply the emollient after drying (whilst the skin is still slightly damp) as a leave-on moisturiser.

    When lesions and fissures are thick and painful, an oil-based emollient with a humectant such as 25% urea is useful as urea is keratolytic. But when the callus is under control, they should switch back to an emollient containing no more than 10% urea, or there is a risk of reducing sebum production via the sebaceous glands and this sebum is an important part of our innate immune system as it contains anti-microbial peptides…sorry, I digress!

    Long term, I know of patients who have greatly benefited from either low-dose methotrexate or oral retinoids, which slow down the proliferation of skin cells associated with the palmoplantar keratoderma aspect of pityriasis rubra pilaris.

    You may find the attached article on the treatment and management of dry heel fissures useful and I hope your relative finds some relief soon.


    *Ivans` sock wrap: At night (just before getting into bed) apply an emollient containing 25% urea all over both feet (apart from between the toes). Then put on a pair of damp (not wet) socks, followed by a pair of dry socks (so the patient is wearing 2 pairs) and leave on overnight. In the morning, much of the hyperkeratotic tissue will slough off with the socks.

    Attached Files:

  3. ALMD

    ALMD Welcome New Poster

    Thank you very much for taking the time in your detailed reply Bel.
    The retinoids haven't done much so far so the consultant is stopping them and starting the methotrexate.
    We will use your advice and see how we get on.
    He'll be very happy he has a plan of action as gesh feeling a little desperate at the moment. What a horrible condition.
    A :)

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