Pityriasis rubra pilaris-like eruption following insulin therapy initiation

Talel Badri; Anissa Zaouak; Ghozlane Lakhoua; Wafaa Koubaa; Sami Fennich; Ahmed Zaiem

doi:10.5826/dpc.0604a04

Pityriasis rubra pilaris-like eruption following insulin therapy initiation

Authors

Talel Badri Department of Dermatology, Habib Thameur Hospital, Faculty of Medicine, University of Tunis El Manar, Tunisia
Anissa Zaouak Department of Dermatology, Habib Thameur Hospital, Faculty of Medicine, University of Tunis El Manar, Tunisia
Ghozlane Lakhoua National Center of Pharmacovigilance, Faculty of Medicine, University of Tunis El Manar, Tunisia
Wafaa Koubaa Laboratory of Pathology, Habib Thameur Hospital, Faculty of Medicine, University of Tunis El Manar, Tunisia
Sami Fennich Department of Dermatology, Habib Thameur Hospital, Faculty of Medicine, University of Tunis El Manar, Tunisia
Ahmed Zaiem National Center of Pharmacovigilance, Faculty of Medicine, University of Tunis El Manar, Tunisia

Keywords:

pityriasis rubra pilaris, insulin, drug-induced, cutaneous rash, skin

Abstract

Pityriasis rubra pilaris (PRP) is a chronic disorder of keratinization of unclear pathogenesis. PRP-like eruptions induced by drugs have rarely been described. A previously healthy 29-year-old man presented with a generalized, rapidly spreading, erythematosquamous dermatosis, that started three days after initiation of subcutaneous insulin therapy for diabetes mellitus type 1. Clinical and histopathological features were consistent with a PRP-like eruption, possibly due to insulin therapy. The patient was switched to insulin analogue therapy and a complete healing of all lesions was achieved after two months. No recurrence was seen after one year of follow-up.

Other possible etiologies of PRP were excluded. The mechanism leading to the occurrence of drug-induced PRP-like eruptions are not clear. Since PRP may occur in the context of immunological anomalies, it is possible that diabetes mellitus type 1 may have been a predisposing condition for the development of PRP in this case.