tag:blogger.com,1999:blog-9870114.post4270058152789850492..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: Psoriasis vs. PRP: Your ThoughtsHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-9870114.post-53518470477807930572012-12-27T15:46:42.103+00:002012-12-27T15:46:42.103+00:00Thank you for your comments and suggestions. They...Thank you for your comments and suggestions. They were very helpful. I agree that PRP is the more likely diagnosis after review of the histopath examination. We can perform immunohistochemistry but not clonality studies unless we send the specimen to KL or Singapore for further examination. I am not sure whether to proceed with IHC studies as the history is rather short - it's only 3 weeks duration and the patient has improved with oral acetretin 20mg bd and lots of moisturizers with ung emulsificant and topical betamethasone dipropionate ointment 1:4 str.<br />Will certainly do IHC studies if the patient do not respond well to retinoids. <br />He was initially treated with oral methotrexate 12.5 mg on the first week but response was very minimal - perhaps too low a dose. He was subsequently changed to oral acitretin 20mg bd which then showed moderate improvement. We did not use any systemic corticosteroids to control the disease.<br /><br /> I have not treated any PRP with oral isotretinoin before but a review of the literature with pubmed showed there are reports of PRP successfully treated with oral isotretinoin. One such report is by Sehgal et al. Efficacy of isotretion in PRP - Unapproved use. Int J Dermatol. 2006;10;1238-40. The authors described 6 patients successfully treated with oral isotretinoin. There were also other reports of PRP treated with NB-UVB light therapy.<br /><br />Henry Foonghttps://www.blogger.com/profile/02804592640968503188noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-46089885515702571902012-12-27T00:29:32.513+00:002012-12-27T00:29:32.513+00:00Agree differential would start with PRP with psori...Agree differential would start with PRP with psoriasis and CTCL as distant 2nd and 3rd choices. I've had only fair results recently with acitretin, better with MTX, and twice recently had short term success with etanercept. No really great treatment for PRP right now. Do readers feel isotretinoin is better than acitretin?<br />Steve StoneDr. Stephen Stonehttps://www.blogger.com/profile/11999118015030901461noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-85030201450122167222012-12-26T21:28:25.381+00:002012-12-26T21:28:25.381+00:00Great case! Looks more c/w PRP, but has CTCL been ...Great case! Looks more c/w PRP, but has CTCL been considered? Is there access to immunohistochemistry or clonality studies? Either way, isotretinoin or MTX could be used to treat all potential causes--not sure how effective acitretin would be in this case. Anonymoushttps://www.blogger.com/profile/14414126252895798390noreply@blogger.com