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However, the relative effectiveness of therapies is unclear. Our objective was to review the published literature on systemic treatment of PRP. A systematic review was conducted on PubMed and the Cochrane Library up to 5 September 2017. Studies evaluating any systemic treatments of PRP (except for historical treatments) were included. Overall, 182 studies met the predefined inclusion criteria, and reported on 475 patients and 652 courses of treatment. 42.0\u00a0% (225\/514) of all patients treated with retinoids achieved an excellent response (isotretinoin: 61.1\u00a0% [102\/167], etretinate: 47\u00a0% [54\/115], and acitretin: 24.7\u00a0% [43\/174]) compared to an excellent response rate of 33.1\u00a0% (53\/160) with methotrexate. Therapy with biologicals was successful in 51.0\u00a0% of patients (71\/133) (ustekinumab: 62.5\u00a0% [10\/16], infliximab: 57.1\u00a0% [28\/49], etanercept: 53.3\u00a0% [16\/30], and adalimumab: 46.4\u00a0% [13\/28]). This review balances effectiveness, side effects, experience, and drug costs in order to suggest a treatment regimen starting with isotretinoin as first\u2010line, methotrexate as second\u2010line and biologicals as third\u2010line treatment for this difficult\u2010to\u2010treat dermatosis.<\/jats:p>","DOI":"10.1111\/ddg.13718","type":"journal-article","created":{"date-parts":[[2018,12,6]],"date-time":"2018-12-06T14:09:26Z","timestamp":1544105366000},"page":"243-259","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Systemic therapies of pityriasis rubra pilaris: a systematic review"],"prefix":"10.1111","volume":"17","author":[{"given":"Christian","family":"Kromer","sequence":"first","affiliation":[{"name":"Department of Dermatology Venereology and Allergology University Medical Centre  G\u00f6ttingen 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