Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(2):e2023094 1

Juvenile Pityriasis Rubra Pilaris
Yihang Xie1, Lixia Xie1, Xin Shi2, Sijia Chen3

1 Chengdu Second People’s Hospital, Chengdu, China

2 The Second Affiliated Hospital of Soochow University, Suzhou, China

3 Traditional Chinese Medicine Hospital of Shangyu, Shaoxing, China

Citation: Xie Y, Xie L, Shi X, Chen S. Juvenile Pityriasis Rubra Pilaris. Dermatol Pract Concept. 2023;13(2):e2023094.  
DOI: https://doi.org/10.5826/dpc.1302a94

Accepted: September 27, 2022; Published: April 2023

Copyright: ©2023 Xie et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Xin Shi, Department of Dermatovenereology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang 
Street, Suzhou 215000, Jiangsu, China. E-mail: shx9@163.com

Case Presentation

A 4-year-old girl, without a prior history of eczema or psori-

asis, presented with a 4-weeks history of extensive erythem-

atous scaly eruption which started on her face and scalp, 

and spread rapidly to her torso and limbs (Figure 1, A, B, E 

and F). She also had well-circumscribed, red-orange, waxy 

plaques on the palms and soles (Figure 1, C and D). Her 

growth and psychomotor development were normal. Histo-

pathology showed basket-like hyperkeratosis, diffuse ortho-

keratosis and spotted parakeratosis, and a dermal superficial 

perivascular lymphocytic infiltration (Figure 1G). The final 

diagnosis was pityriasis rubra pilaris.

Teaching Point

Pityriasis rubra pilaris is a rare inflammatory skin disease that 

affects men and women of all ages, which presents with hy-

perkeratotic follicular papules, erythematous-desquamative 

plaques, palmoplantar keratoderma [1]. Its classification 

into five subgroups is based on age at onset, clinical course, 

morphologic features, and prognosis [2]. We present a type 

III pityriasis rubra pilaris. The differential diagnosis includes 

psoriasis vulgaris, perifollicular keratosis, lichen spinulosus.



2 Image Letter | Dermatol Pract Concept. 2023;13(2):e2023094

Figure 1. (A,B,E,F) Extensive erythematous scaly eruption on the trunk and limbs. (C,D) Well-circumscribed, red-orange, waxy plaques 

on the patient palms and soles. (G) Basket-like hyperkeratosis, diffuse orthokeratosis and spotted parakeratosis, and a dermal superficial 

perivascular lymphocytic infiltration (H&E x400).

References

1. Wang D, Chong VC, Chong WS, Oon HH. A Review on 

Pityriasis Rubra Pilaris. Am J Clin Dermatol. 2018;19(3):377-

390. DOI:10.1007/s40257-017-0338-1. PMID: 29302927.

2. Cohen PR, Prystowsky JH. Pityriasis rubra pilaris: a review 

of diagnosis and treatment. J Am Acad Dermatol. 1989;20  

(5 Pt 1):801-807. DOI:10.1016/s0190-9622(89)70093-1. PMID: 

2654219.