Pityriasis rubra pilaris has no single effective therapy and there are some cases resistant to multiple treatments. Psoriasis has clinical and therapeutic response overlaps with pityriasis rubra pilaris and there are several therapies common to both, such as retinoids, methotrexate, cyclosporine A, phototherapy, and most recently infliximab. We report a case of a 10-year-old boy with pityriasis rubra pilaris unresponsive to topical corticosteroids, salicylic acid, pimecrolimus, calcitriol, calcipotriol, ultraviolet B targeted phototherapy, isotretinoin, systemic PUVA, acitretin, and etanercept. He was treated with efalizumab 1 mg/kg weekly and a successful outcome was obtained with a 50% improvement after the first dose. The patient remains in remission after 9 months of treatment.
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