title: Acitretin therapy is effective for psoriasis associated with human immunodeficiency virus infection.
abstract: OBJECTIVE
  To determine the safety, tolerability, and effectiveness of a newer retinoid, acitretin, as monotherapy for psoriasis associated with human immunodeficiency virus infection (PS-HIV).
  
  
  METHODS
  Pilot investigation.
  
  
  METHODS
  An academic medical center.
  
  
  METHODS
  Eleven patients selected from volunteers with PS-HIV were enrolled in a 20-week treatment protocol. Two patients discontinued participation in the study because of worsening psoriasis; a third patient was unable to continue treatment after having a myocardial infarction, presumably unrelated to acitretin therapy.
  
  
  METHODS
  Each patient received an optimized dose of acitretin during the period of observation. Clinical and laboratory assessments were performed every 2 weeks during the trial.
  
  
  METHODS
  The Psoriasis Area and Severity Index was used to assess the clinical response to treatment. To monitor for toxic drug effects, a panel of laboratory parameters, including complete blood cell count, biochemistry profile, urinalysis, HLA typing, skin biopsy for histological examination, and T-cell counts, was performed.
  
  
  RESULTS
  Six (54%) of 11 patients with PS-HIV achieved good to excellent responses using acitretin monotherapy. Four patients (36%) achieved complete clearing. There was no evidence of a correlation between the pretreatment measures of immunosuppression and the therapeutic response. Parameters of immunosuppression were not exacerbated by acitretin therapy.
  
  
  CONCLUSIONS
  Acitretin is a safe and effective treatment for PS-HIV. Both skin and joint manifestations of PS-HIV responded to acitretin therapy in most patients. Optimal results were achieved with a dose of 75 mg/d. The adverse effects were moderate and well tolerated. Acitretin does not appear to have immunosuppressive properties. A formal randomized clinical trial is warranted.
authors.affiliation: Department of Dermatology, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Buccheri
authors.forename: B R
authors.initials: BR
authors.lastname: Katchen
authors.forename: A J
authors.initials: AJ
authors.lastname: Karter
authors.forename: S R
authors.initials: SR
authors.lastname: Cohen
mesh_terms: D017255:Acitretin / Q000627:therapeutic use*; D000328:Adult; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*
chemical_list: D017255:Acitretin