PSORIASIS/REITER'S SYNDROME in the HIV POSITIVE PATIENT

By Gary M. White, MD


See also psoriasis.

Clinical

A spectrum of disease may occur in HIV positive patients from papulosquamous lesions of psoriasis to manifestations of Reiter's syndrome. All the forms of psoriasis may be seen including small or large plaques, pustular lesions of the palms and soles, circinate balanitis, psoriasis inversa and erythrodermic psoriasis. Patients may or may not have a family history of psoriasis. Those who had psoriasis before seroconverting may experience a flare. Psoriatic arthritis is more common in HIV positive patients with psoriasis.

Treatment

Potent topical steroids should be tried along with emolliation but are often met with mixed results. Acitretin is effective therapy. Both skin and joint symptoms respond in most patients. UVB has been reported successful without deterioration of immune status in 14 patients [PDPIPM 1995;11;107]. The use of immunosuppressive therapies such as MTX, PUVA, or CSA is best avoided if possible.

The TNF agents, e.g. etanercept, adalimumab [J Drugs Detmatol 2014:13;868] have been used cautiously but with benefit in HIV-infected patients with psoriasis.

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