Severe Cicatricial Ectropion as a Complication of Pityriasis Rubra Pilaris

Summary: Objective: To describe a case of severe cicatricial ectropion secondary to pityriasis rubra pilaris (PRP) and discuss importance of multidisciplinary dermatology and ophthalmology management. Methods: An 83-year-old male presented with diffuse pink papules and scaly plaques on the trunk, extremities, and face consistent with PRP with significant progression despite the prednisone course (Figure 1). As the rash progressed, the patient also began experiencing severe cicatricial ectropion of both lower eyelids causing increased tightness, worsening vision, epiphora, and exposure keratopathy. (Figure 2). A multidisciplinary management plan between dermatology and ophthalmology was made to reduce patient’s inflammatory burden before reconstructive surgery. The patient initially received triamcinolone and cyclosporine but was later switched to infliximab due to continued rash progression. Next, reconstructive surgery to correct ectropion with full-thickness grafting was planned. The graft was harvested from the retro-auricular non-hair bearing skin and was oversized by about 50% compared to the defect size. Results: The patient reported significant cutaneous improvement after infliximab. Six weeks post-surgery, his eye irritation and epiphora improved substantially, with well-healed surgical wounds. (Figure 3). Conclusion: This case emphasizes the ocular complications of PRP and the need for medical management before surgical correction. A multidisciplinary approach is critical for successful outcomes.