SHM Converge Scientific Abstract ePoster Gallery-A Rare Post-Infectious Rash: Pityriasis Rubra Pilaris After Covid-19 Infection

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This document describes pityriasis rubra pilaris (PRP), a rare inflammatory skin disorder that is often mistaken for psoriasis or cutaneous lupus. PRP has six Griffith subtypes and commonly begins on the face and scalp, spreading downward in a cephalocaudal pattern. A key clinical clue is the presence of “islands of sparing” amid diffuse erythema and scaling. Unlike psoriasis, PRP typically lacks nail findings such as pitting and oil-drop changes. It is also generally not responsive to systemic steroids.<br /><br />The case report involves a 55-year-old woman who developed a widespread rash about three weeks after a mild COVID-19 infection. Her eruption began as patchy, erythematous plaques with diffuse scaling on the scalp, face, chest, and back, eventually progressing to erythroderma involving about 90% of her body surface area. Initial workup showed a positive ANA, which led to a mistaken diagnosis of cutaneous lupus and treatment with prednisone, hydroxychloroquine, and mycophenolate. However, skin biopsy later demonstrated psoriasiform dermatitis with alternating orthokeratosis and parakeratosis and follicular plugging, confirming PRP.<br /><br />She also had palm and sole keratoderma and classic islands of sparing, supporting the diagnosis. Because of persistent symptoms, she was treated with acitretin, topical triamcinolone, tapering of prednisone, and later ixekizumab.<br /><br />The report emphasizes that PRP can occur as a rare post-infectious complication after COVID-19 and may be misdiagnosed as other inflammatory dermatoses. Early recognition of its characteristic clinical and histopathologic features is important to guide effective treatment and reduce complications such as impaired quality of life and depression.

Asset Subtitle

Philicia Duncan

Meta Tag

Author List Philicia Duncan

Category Clinical Vignettes

Concept Pityriasis Rubra Pilaris

Concept Cephalocaudal Progression

Concept Islands of Sparing

Concept Erythroderma

Concept Palmoplantar Keratoderma

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center

Presenting Author Philicia Duncan

Track Adult

Keywords

pityriasis rubra pilaris

PRP

COVID-19

erythroderma

islands of sparing

psoriasiform dermatitis

cutaneous lupus

acitretin

ixekizumab

follicular plugging

Pityriasis Rubra Pilaris

Cephalocaudal Progression

Islands of Sparing

Erythroderma

Palmoplantar Keratoderma