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http://dx.doi.org/10.22246/jikm.2020.41.5.787

A Case Report of Korean Medicine Treatment for Adult-type Pityriasis Rubra Pilars  

Jeon, Sang-woo (Dept. of Internal Medicine, College of Korean Medicine, Woo-Suk University)
Kang, Sei-young (Dept. of Internal Medicine, College of Korean Medicine, Woo-Suk University)
Publication Information
The Journal of Internal Korean Medicine / v.41, no.5, 2020 , pp. 787-799 More about this Journal
Abstract
Objectives: Pityriasis rubra pilaris (PRP) is a rare papulosquamous disorder with unknown etiology. Studies on adults have not been conducted yet in Korean medicine. We report the progress of Korean medicine treatment for adult-type pityriasis rubra pilaris. Methods: A 62-year-old female patient was diagnosed with PRP in June 2019. After the diagnosis of PRP, retinoid treatment was continued for about 6 months, and then the drug was switched to an oral immunosuppressant. However, the patient's symptoms did not improve, but instead worsened. The patient was treated with Mihudeungsikjang-tang and acupuncture therapy. We evaluated her treatment progress based on the Dermatology Life Quality Index (DLQI), a visual analogue scale (VAS), and the changes in the patient's subjective symptoms. Results: After Korean medicine treatment, the DLQI and VAS scores improved from 18 points to 16 points and from 6 points to 4 points, respectively. The whole-body itching and scaling were reduced by 30% compared to pretreatment. The itching and pain in the neck, which had been severely symptomatic, decreased by 50%. The pain and dysesthesia in the upper and lower extremities disappeared, but the erythema still remained. Conclusions: Conventional treatments for PRP have limitations due to adverse effects and difficulty in treating refractory forms. Korean medicine treatment is worth considering as it can complement the limitations of conventional treatments, although more studies will be needed.
Keywords
Korean medicine; pityriasis rubra pilairs (PRP); Sasang constitutional medicine; Mihudeungsikjang-tang; dermatology life quality index (DLQI);
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1 Christian K, Robert S, Daniel C, Rotraut M. Systemic therapies of Pityriasis rubra pilaris: a systematic review. Treatment of Pityriasis rubra pilaris type I: a systematic review Pityriasis rubra pilaris--a retrospective single center analysis over eight years. J Dtsch Dermatol Ges 2019;17(3):243-59.
2 Jeong JT, Kye YC, Kim SN. A Clinical and Histopathologic Study of Pityriasis rubra pilaris. Ann Dermatol 2002;40(4):363-74.
3 Sim SY. A Case of Honyoja : Pityriasis rubra pilaris with good response to Korean Medicine. J Korean Med Ophthalmol Otolaryngol Dermatol 2015;28(4):215-20.   DOI
4 Tarral C Observation CXVIIII In: Rayer P, ed. Traite theorique et pratique des maladies de la peau. Vol 2. Paris: Bailliere; 1835, p. 158-9.
5 Devergie A. Traite pratique des maladies de la peau. Paris: Masson; 1857, p. 454-64.
6 Besnier E. Observation pour server a historic clinique du, Pityriasis rubra pilaris. Am Dermatol Syphil 1889;10:253-87.
7 Griffiths WA. Pityriasis rubra pilaris: the problem of its classification. J Am Acad Dermatol 1992;26(1):140-2.   DOI
8 Tarral C. General psoriasis-desquamation from the parts covered by hair. In: Rayer P, editor. A theoretical and practical treatise on the diseases of the skin. 2nd ed. London: Baillere 1835, p. 648-9.
9 Griffiths WA, Judge MR, Leigh IM. Disorders of keratinization-Pityriasis rubra pilaris. In: Champion RH, Burton JL, Burns DA, et al, editors. Text Book of dermatology. 6th ed. London: lackwell Science; 1988, p. 1539-45.
10 Gold Smith LA, Baden HP. Pityriasis rubra pilaris. In: Freeberg IM, Eisen AZ, Wolff K, et al, editors. Dermatology in general medicine. Vol 1 6th ed. London: Mc-Graw Hill Publication; 2003, p. 442-4.
11 Bragg J, Witkiewicz A, Orlow SJ, Schaffer JV. Pityriasis rubra pilaris, type IV. Dermatol Online J 2005;11(4):14.
12 Mortimer PS, Dawber RP. Dermatologic disease of the nail unit other than psoriasis and lichen planus. Dermatol Clin 1985;3(3):401-7.   DOI
13 Lambert DG, Dalac S. Nail changes in type 5 Pityriasis rubra pilaris. J Am Acad Dermatol 1989;21(4Pt1):811-2.   DOI
14 Sehgal VN, Srivastav G. (Juvenile) Pityriasis rubra pilaris. Int J Dermatol 2006;45(4):438-46.   DOI
15 Caldarola G, Zampetti A, De Simone C, Massi G, Amerio P, Feliciani C. Circumscribed Pityriasis rubra pilaris type IV. Clin Exp Dermatol 2007;32(4):471-2.   DOI
16 Misery I, Faure M, Claidy A. Pityriasis rubra pilaris and human immunodeficiency virus infection-type 6 Pityriasis rubra pilaris? Br J Dermatol 1996;135(6):1008-9.   DOI
17 Fung PM. Pityriasis rubra pilaris: an Update Review. Hong Kong J Dermatol 2001;9(1):10-6.
18 Ma JM, Zhang YF. Pityriasis rubra pilaris. Shandong Journal of Traditional Chinese Medicine 1993;13(5):49.
19 Wang CX. Experience of TCM differentiation and treatment of pityriasis pilaris. Journal of Sichuan Traditional Chinese Medicine 2009;27(5):35.
20 Yang Z, Cai NN. Current status of TCM treatment of Pityriasis rubra pilaris. JBUTCM 2006;13(6):45-6.
21 Department of Sasang constitutional medicine, Collage of national Korean medicine. Sasang constitutional medicine(Revised supplement). Seoul: Jipmoondang; 2016, p. 670, 692 710-11, 723
22 Son JM, Choi IH. A Literature Study about the Correlation between Genetic Studies on Atopic Dermatitis, Sasang Constitution, and Sasang Constitutional Study on Atopic Dermatitis. J Korean Med Ophthalmol Otolaryngol Dermatol 2005;18(2):1-9.
23 Kim YH, Park YS. Effect of Acanthopanacis cortex Water Extract on Antioxidative Activity, Lipid Profile and Epidermal Thickness in DNCB-induced Allergic Contact Dermatitis Animal Model. Korean J Food Sci Technol 2006;38(5):668-73.
24 Park HS, Joo JC, Lee EJ. Clinical Practice Guideline for Taeyangin Disease of Sasang Constitutional Medicine. J Sasang Constitut Med 2015;27(1):71-81.   DOI
25 Song DU, Min GY, Hong SY, Lim SE, Huh J, Sohn YJ, et al. Effects of KMS on the DNCB induced animal Model of Atopic Dermartitis. J Korean Med 2019;40(1):63-77.
26 Kim YJ, Song CH. Anti-Inflammatory Effect of Bower Actinidia in LPS-Stimulated RAW264.7 Cells. Korean Journal of Acupuncture 2013;30(4):243-51.   DOI
27 Fuchs-Telem D, Sarig O, van Steensel MA, Isakov O, Israeli S, Nousbeck J, et al. Familial Pityriasis rubra pilaris Is Caused by Mutations in CARD14. Am J Hum Genet 2012;91(1):163-70.   DOI
28 An SM, Kim HG, Choi EJ, Hwang HH, Lee ES, Baek JH, et al. Screening for Anti-inflammatory Activities in Extracts from Korean Herb Medicines. J Soc Cosmet Scientists Korea 2014;40(1):95-108.   DOI
29 Ryu HW, Kim YS, Lim EM. The Antiinflammatory Effects of Chaenomelis Fructus Herba Water Extract on Mouse RAW 264.7 Cell. J Korean Obstet Gynecol 2012;25(3):1-15.   DOI
30 Kim HS, Jeon IH, Mok JY, Kang HJ, Jang SI. Antipruritic Effects of Ethanol Extracts from Perillae Japonicae Semen leaves and Chaenomelis Fructus. J Physiol & Pathol Korean Med 2012;26(3):314-9.
31 Koch L, Schoffl C, Aberer W, Massone C. Methotrexate treatment for Pityriasis rubra pilaris: a case series and literature review. Acta Derm Venereol 2018;98(5):501-5.   DOI
32 Parna E, Aluoja A, Kingo K. Quality of life and emotional state in chronic skin disease. Acta Derm Venereol 2015;95(3):312-6.   DOI
33 Gemmeke A, Schonlebe J, Koch A, Wollina U. Pityriasis rubra pilaris - a retrospective single center analysis over eight years. J Dtsch Dermatol Ges 2010;8(6):439-44.
34 Soeprono FF. Histologic criteria for the diagnosis of Pityriasis rubra pilaris. Am J Dermatopathol 1986;8(4):277-83.   DOI
35 Klein A, Landthaler M, Karrer S. Pityriasis rubra pilaris: a review of diagnosis and treatment. Am J Clin Dermatol 2010;11(3):157-70.   DOI
36 Eastham AB, Femia AN, Qureshi A, Vleugels RA. Treatment options for Pityriasis rubra pilaris including biologic agents: a retrospective analysis from an academic medical center. JAMA Dermatol 2014;150(1):92-4.   DOI
37 Goldsmith LA, Weinrich AE, Shupack J. Pityriasis rubra pilaris response to 13-cis-retinoic acid (isotretinoin). J Am Acad Dermatol 1982;6(4pt2suppl):710-5.   DOI
38 Dicken CH. Treatment of classic Pityriasis rubra pilaris. J Am Acad Dermatol 994;31(6):997-9.   DOI
39 Molin S, Ruzicka T. Treatment of refractory Pityriasis rubra pilaris with oral alitretinoin: case report. Br J Dermatol 2010;163(1):221-3.   DOI
40 Schmitt L, Inhoff O, Dippel E. Oral alitretinoin for the treatment of recalcitrant Pityriasis rubra pilaris. Case Rep Dermatol 2011;3(1):85-8.   DOI
41 Amann PM, Susic M, Gluder F, Berger H, Krapf W, Loffler H. Alitretinoin (9-cis retinoic acid) is effective against Pityriasis rubra pilaris: a retrospective clinical study. Acta Derm Venereol 2015;95(3):329-31.   DOI
42 Pampin A, Gomez-de la Fuente E, Caro Gutierrez MD, Lopez-Estebaranz JL. Successful treatment of atypical adult Pityriasis rubra pilaris with oral alitretinoin. J Am Acad Dermatol 2013;69(2):105-6.   DOI
43 Kromer C, Sabat R, Celis D, Mossner R. Systemic therapies of Pityriasis rubra pilaris: a systematic review. J Dtsch Dermatol Ges 2019;17(3):243-59.
44 Moretta G, De Luca EV, Di SA. Management of refractory Pityriasis rubra pilaris: challenges and solutions. Clin Cosmet Investig Dermatol 2017;9(10):451-7.   DOI
45 Hsu DC, Katelaris CH. Long-term management of patients taking immunosuppressive drugs. Aust Prescr 2009;32(3):68-71.   DOI
46 Muhammad Y, Amandeep G, Pankaj B, Sidharth S. "Corticosteroid Adverse Effects" July 4, 2020. https://www.ncbi.nlm.nih.gov/books/NBK531462/.
47 Korean Dermatological Society Textbook Compilation Committee. Text of Dermatology. 6th editon. Seoul: Sungbo Medical booke store; 2014, p.316-8.
48 Griffiths WA. Pityriasis rubra pilaris. Clin Exp Dermatol 1980;5(1):105-12.   DOI
49 Klein A, Landthaler M, Karrer S. Pityriasis rubra pilaris: a review of diagnosis and treatment. Am J Clin Dermatol 2010;11(3):157-70.   DOI