Features of this condition vary greatly from person to person. Signs and symptoms often get worse over time and may affect the skin, nails, mucous membranes, and eyes. Signs and symptoms may include:

• Redness and scaling of the skin and scalp, which often develops into itchy, orange-red plaques. Plaques may first occur on only some parts of the body, but may eventually spread over the whole body. The elbows, knees, ankles, hands and feet are most commonly affected.
• Thickening of the skin on the palms and soles (palmoplantar keratoderma).
• Thickening, discoloration, or shedding of the nails.
• Thinning of the hair.
• Plaques and irritation in the mouth.
• Dryness of the eyes and/or ectropion (outward turning of the eyelid).
• Reduced quality of life associated with persistent pain, itching, or sleep disturbances.

PRP can be difficult to treat and many treatment options have been tried. There is little information on which treatments are best because none have been studied in large clinical trials. Treatment options may vary based on the symptoms in each person but often involve a combination of medicines taken internally and applied topically to the skin.

Topical therapy options may include corticosteroids, keratolytics, calcipotriol, tretinoin, and tazarotene. For people with mild PRP, using one or more of these may be enough to control symptoms.

Most people with PRP also need additional medicines to control their symptoms, especially if the condition affects a large part of the body.Oral retinoids are usually tried first. Examples include acitretin and isotretinoin.Methotrexate, an immune system suppressant, may be tried when oral retinoids are not safe for a particular person, or when they have stopped working. Other immune system suppressants that have been helpful in some case reports include cyclosporine and azathioprine.Biologic therapies may be another option, based on limited data. Examples include various biologic TNF-alpha inhibitors and ustekinumab.

Many of these treatments have shown results in only a few patients, and some can have serious side effects. The risks and benefits of each treatment option should be discussed with your doctor.

• Type I (classic adult type), the most common type, goes away on its own within 3 years in about 80% of people. After it goes away, relapses are uncommon.
• Type II (atypical adult type) can last for a very long time, sometimes more than 20 years.
• Type III (classic juvenile type) usually goes away within one year. Rarely, this type persists for a longer period of time.
• Type IV (circumscribed juvenile) may be associated with alternating periods of getting better and worse. About one-third of people with this type have improvement with age.
• Type V (atypical juvenile type) is usually chronic.
• Type VI (HIV-associated) tends to be resistant to most treatments.