HIV-associated psoriasis: pathogenesis, clinical features, and management.
Psoriasis is a chronic papulosquamous skin disease that is thought to be a T-cell-mediated autoimmune disorder of keratinocyte proliferation. The association between psoriasis and HIV infection seems paradoxical, but insights into the role of T-cell subsets, autoimmunity, genetic susceptibility, and infections associated with immune dysregulation might clarify our understanding of the pathogenesis of psoriasis with HIV in general. HIV-associated psoriasis can be clinically confusing because several comorbid skin disorders in patients with HIV can mimic psoriasis. Phenotypic variants such as a Reiter's syndrome or fulminant erythroderma provide diagnostic clues to underlying immunodeficiency. The management of moderate and severe HIV-associated psoriasis is challenging, although patients typically improve with highly active antiretroviral therapy. Conventional systemic treatments might be contraindicated or need dose adjustment to avoid toxicity. New biological treatments in this setting are promising and warrant further study.
Morar
Nilesh
N
Department of Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK. n.morar@imperial.ac.uk
Willis-Owen
Saffron A
SA
Maurer
Toby
T
Bunker
Christopher B
CB
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D012871:Skin Diseases / Q000145:classification / Q000209:etiology
D015395:Histocompatibility Antigens Class I