The therapeutic challenge in this case is one that often is encountered in clinical practice. The health care system often may pose a barrier to diagnosis by inhibiting particular services required for adequate patient care. For our patient, diagnosis was delayed by several weeks due to difficulties obtaining a diagnostic skin biopsy. When faced with challenges from health care infrastructure, creativity with treatment options, such as finding an empiric treatment option (cyclosporine in this case), must be considered.
Systemic retinoids have been found to be efficacious treatment options for PRP, but when dealing with a woman of reproductive age, reproductive preferences must be discussed before identifying an appropriate treatment regimen.1,13-15 The half-life of acitretin compared to isotretinoin is 2 days vs 22 hours.6,16 With alcohol consumption, acitretin can be metabolized to etretinate, which has a half-life of 120 days.17 In our patient, isotretinoin was a more manageable option to allow for greater reproductive freedom upon treatment completion.