Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Erythrodermic PRP
Pityriasis rubra pilaris can generalise into erythroderma with shivering, temperature dysregulation, fluid loss, oedema, infection and cardiorenal strain.
Action: Arrange immediate same-day dermatology and acute medical assessment, check ABCDE and fluid balance, and begin gentle barrier support while excluding infection, drug reaction and other erythrodermas.
Synopsis
Recognise the distinctive follicular, palmoplantar and island-sparing pattern of pityriasis rubra pilaris, confirm rare disease thoughtfully, protect erythrodermic physiology, and refer for specialist treatment.
PRP is a rare inflammatory keratinisation disorder characterised by rough follicular papules, coalescing orange-red or brown-red scaly plaques, islands of sparing and waxy palmoplantar keratoderma.
Classic adult PRP often starts on scalp or face and spreads downwards; orange colour may be subtle in deeply pigmented skin, so texture, follicular plugging and spared islands are more reliable.
Palms and soles become thick, orange or waxy and fissured; pain, walking and hand function are essential severity outcomes.
Key red flags
Near-total skin inflammation with shivering, fever or hypothermia, tachycardia, oedema, reduced urine output or breathlessness requires emergency assessment.
Erythrodermic deterioration
Near-total involvement with shivering, temperature change, oedema, tachycardia, oliguria or breathlessness indicates barrier failure and needs immediate acute care.
Investigation priorities
01
First-line full skin, scalp, nail and mucosal examinationFirst stepFirst line
Identify follicular papules, direction of spread, islands of sparing, palmoplantar keratoderma and features of competing erythrodermas.
Management branches
First-lineConfirm the rare diagnosis
Follicular papules, spared islands and palmoplantar keratoderma suggest PRP without physiological instability.
Document onset, direction of spread, family and medicine history, HIV risk, full morphology and functional impact across skin tones.
Refer to dermatology for confirmation and select a representative biopsy when psoriasis, drug eruption, lymphoma or inherited keratinisation disease remains plausible.
Key medicines
Emollient or soap substituteApply generously and frequently to dry or fissured skin and use as a wash substitute, coordinating applications with active treatment and non-adhesive dressings.
Betamethasone valerate 0.1% cream or ointmentApply thinly to appropriate active plaques once or twice daily for up to 4 weeks, then reduce frequency or step down after improvement.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.