Pityriasis rubra pilaris following exposure to dolomite
A 30-year-old man was referred to St-Alzahra Hospital dermatology clinic, Isfahan, Iran in 2010 because of erythematous, scaly, and slightly itchy eruption all over the body. The eruption had started about 4 months ago from the scalp and progressed to involve other parts of the body in the cephalocaudal pattern.\nIn physical examination, numerous papules with central keratotic pulg were found on the upper chest, upper back, neck, arms, and face [].\nPalms and soles were hyperkeratotic with yellow-orange hue and the nails were hyperkeratotic and thickened [].\nThe patient stated that the lesions developed following contact with dolomite as he was truck driver in a dolomite factory.\nHa had no family history of pityriasis rubra pilaris (PRP) and in past medical history, he revealed no history of the recent infection or fever or use of any medication.\nA clinical diagnosis of PRP was suggested for the patient and a biopsy was performed from the hand.\nIn histological examination, psoriasiform dermatitis along with parakeratosis and orthokeratosis and focal acantholytic changes consistent with PRP was found.\nHe was treated with Oral acitretin (Actavis UK Ltd) (50 mg/day) with minimal improvement and therefore oral cyclosporine (Novartis, UK) (300 mg/day) was added to his regimen.\nAfter 3 months, (about 70%) of his lesions resolved but he returned to his job in dolomite factory and his lesions recurred again.\nThis time, in addition to acitretin and cyclosporine, Narrow Band UVB (starting dose of 50 (mJ/cm2)) was started for the patient and the patient was advised not to have more contact with dolomite. He was visited monthly during treatment course.\nFollowing this treatment protocol, the lesions cleared almost completely during 15 weeks (30 sessions of Narrow band UVB).