04.00.00 What are the stages of PRP?
Editor’s Note: This is a revision of earlier attempts to identify patterns and phases of Type I PRP. It represents a composite of support group e-mail messages and discussions over the years. In addition, dermatologists have closely reviewed this for accuracy.
The medical literature states this form of PRP last for three years. This composite overview suggests it is too difficult to identify the exact start date and it is more helpful to indicate a range of 2 to 4 years.
Type I is the most common form of PRP and it has a documented progression including gradual improvement. Hopefully others can identify and report limitations of the following description and any serious errors.
Our major support group question, through all of these phases, is: Do prescribed immunosuppressive, retinoid and other medications (Methotrexate, Soriatane, etc.) impact the overall timetable and speed healing? Involvement with the support group over many years suggests we still do not have an answer. Our self reports are too imprecise and too varied.
Please carefully evaluate claims of success or failure by asking questions. In the absence of carefully controlled clinical research studies, our knowledge is still limited.
Other forms of PRP among children and young adults have a more variable set of symptoms and may possibly respond to selected medications.
PHASES of TYPE I PRP (adult onset) A guide for patients and their families
Until someone conducts a proper survey with a sufficient sampling of PRP patients, the assignment of duration is inaccurate and/or misleading. I prefer to think in terms of progression/
PRE-EMERGENT (undetermined period of time)
Earliest signs and symptoms, often recognized after-the-fact, but not identified as a distinct problem or a specific medical condition. Possible mild signs include dandruff, limited red patches or scaling of the skin. Likely to exist for months, it is impossible to determine an exact beginning.
Life was as normal as life had been. If you took a snapshot before PRP
= 0 to 4 months
EMERGENT – Recognition that something is going on with the skin. Redness, scaling begin to appear on other parts of the body: scalp, hands, torso, legs, and feet. Spread may go from the head and face, then downward, to eventually cover all other areas of the body. Misdiagnosis and mistreatment is likely during this phase. These diagnoses include: contact dermatitis; non- specific dermatitis, psoriasis, allergy, etc. Symptoms can occur and become clearly visible in a few days or weeks.
+ 4 to 8 months
INTENSE – Most or all of the entire body becomes red with some “islands of sparing”. Severe symptoms include: shedding of the skin; edema or swelling of legs, face, feet, hands; redness and abnormal skin appearance; dryness; thickened skin buildup on palms of hands and bottoms of feet; itchiness; eyelid and eye problems; thinning or loss of hair; poor body temperature regulation; loss of energy; weakness; nail growth problems. Though there can still be misdiagnosis, PRP can be identified. Usually develops within one or two months following the Emergent phase. Estimated to last for approximately 4 to 8 months.
+ 7 to 11 months
EARLY RESOLUTION – Slowly begin to recognize the earliest signs of improvement. Swelling subsides and “islands of sparing” increase. Other symptoms begin to change but cyclical pattern may be noticed: improvement – setback – improvement – setback, etc. Estimated to last for 7 to 11 months.
+ 12 to 18 months
CONTINUING RESOLUTION – Gradual resolution of most severe symptoms. Minor skin patchiness may remain on arms, legs and torso. Normal appearance of face returns. Estimated additional time is 12 to 18 months.
FULL REMISSION/CLEARING – Skin has a ”normal” appearance though some may still see mild, uneven coloration or patches on the skin. Estimated total PRP time frame is 24 to 40 months.