Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation.
BACKGROUND
Patients with psoriasis and HIV infection often present with more severe and treatment-refractory cutaneous disease. In addition, many of these patients have significant psoriatic arthritis. Many effective drugs for psoriasis and psoriatic arthritis are immunosuppressive. Therefore, therapy for the HIV-infected patient is more challenging, requiring both careful consideration of the potential risks and benefits of treatment and more fastidious monitoring for potential adverse events.


OBJECTIVE
A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to arrive at a consensus on therapy for psoriasis in patients with HIV.


METHODS
A MEDLINE search of the terms "psoriasis," "psoriatic arthritis," "human immunodeficiency virus (HIV)," and "HIV skin diseases" was performed and literature relevant to HIV-associated psoriasis and the treatment of HIV-associated psoriasis were reviewed.


RESULTS
Based on a review of the literature, 29 reports were included as evidence in this review. Topical therapy is the first-line recommended treatment for mild to moderate disease. For moderate to severe disease, phototherapy and antiretrovirals are the recommended first-line therapeutic agents. Oral retinoids may be used as second-line treatment. For more refractory, severe disease, cautious use of cyclosporine, methotrexate, hydroxyurea, and tumor necrosis factor-alpha inhibitors may also be considered.


CONCLUSIONS
There are no randomized, placebo-controlled trials evaluating the therapeutic efficacy or safety of treatments for patients with HIV-associated psoriasis; consequently, the evidence supporting this review consists mainly of case reports or case series.


CONCLUSIONS
HIV-associated psoriasis is often refractory to traditional treatments. Treatment is challenging and requires careful consideration and should be tailored to patients based on disease severity and the input from an infectious disease specialist. Close monitoring for potential adverse events is necessary.
Menon
Kavita
K
Department of Dermatology, New York University, New York, New York 10016-6497, USA.
Van Voorhees
Abby S
AS
Bebo
Bruce F
BF
Gladman
Dafna D
DD
Hsu
Sylvia
S
Kalb
Robert E
RE
Lebwohl
Mark G
MG
Strober
Bruce E
BE
D000287:Administration, Topical; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D019317:Evidence-Based Medicine; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015201:Meta-Analysis as Topic; D010789:Phototherapy; D011565:Psoriasis / Q000150:complications* / Q000188:drug therapy*; D012176:Retinoids / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D044966:Anti-Retroviral Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D012176:Retinoids; D014409:Tumor Necrosis Factor-alpha