Effectiveness of Infliximab in Pityriasis Rubra Pilaris Is Associated with Pro-Inflammatory Cytokine Inhibition

Abstract

Background: Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease. Recently, the use of anti-TNF-α in treating resistant forms of PRP has been reported. Objectives: To evaluate the clinical efficacy of infliximab in the treatment of PRP along with the evolution of secretion of some serum cytokines during treatment. Methods: Patients presenting widespread PRP were included consecutively and treated with infliximab. We compared cytokine profiles (notably CXCL-10 and TNF-α) by ELISA in sera from both patients with PRP and controls (healthy/psoriasis) at the time of diagnosis and after clinical remission (PRP). Results: 4 patients were treated with infliximab and achieved complete remission without any recurrence after treatment ending. The serum level of TNF-α and CXCL-10 was increased at the time of inclusion and normalized after treatment. Analysis of the typical component of the T helper cell 1 (Th1) and Th2 cytokine network did not show modification. Conclusion: Infliximab is an effective treatment of PRP. The analysis of the cytokine profile is in agreement with an absence of further recurrence of PRP by an early and unique inflammatory mechanism without significant underlying autoimmunity.