Jashin J. Wu (ed.)Clinical Cases in PsoriasisClinical Cases in Dermatology10.1007/978-3-319-52779-6_21

21. HIV Infection in a 44-Year-Old with Psoriasis

Mina Amin¹, Kavita Darji², Daniel J. No³ and Jashin J. Wu⁴

(1)

University of California, Riverside School of Medicine, Riverside, CA, USA

(2)

Saint Louis University School of Medicine, St. Louis, MO, USA

(3)

Loma Linda University School of Medicine, Loma Linda, CA, USA

(4)

Wu Medical Associates, Inc., Los Angeles, CA, USA

Jashin J. Wu

Email: jashinwu@gmail.com

Keywords

HIVPsoriasisTopicalPhototherapyApremilastCorticosteroidsImmunosuppressant

A 44-year-old male with a 4-year history of HIV presented for follow-up of the management of his psoriasis after a failed trial with acitretin. The patient discontinued acitretin due to transaminitis and gastrointestinal-related side effects. He previously used narrowband ultraviolet phototherapy and topical corticosteroids with minimal benefit. The review of systems was unremarkable, and there was no evidence of AIDS-defining conditions. He denies other medical conditions. The patient is compliant with his combination antiretroviral medications.

On physical examination, there were erythematous scaly indurated papules and plaques on the back, chest, and bilateral upper and lower extremities. Approximately 10% of the body surface area was affected.

Based on the case description, what is the best treatment recommendation for this patient?

1.

Methotrexate
2.

Infliximab
3.

Acitretin
4.

Apremilast
5.

Cyclosporine

Treatment

Apremilast.

Discussion

The prevalence of psoriasis in the HIV-infected population is similar to that of the general population, although HIV-infected individuals frequently present with a more severe form of psoriasis (Bartlett et al. 2007). Psoriasis can present at any stage of HIV infection at different degrees of severity (Mallon and Bunker 2000). Psoriasis may be the initial manifestation of HIV infection and can indicate a poor prognosis, as the degree of psoriasis is correlated with the level of immunodeficiency. Therefore, it may be beneficial to consider HIV testing in patients with new-onset psoriasis (Montazeri et al. 1996; Bartlett et al. 2007).

Plaque, guttate, inverse, and erythrodermic psoriasis are the most common types of psoriasis that present in HIV-infected individuals (Menon et al. 2010). Multiple types of psoriasis can occur in one patient simultaneously. Psoriatic arthritis more commonly affects HIV-positive than HIV-negative patients with psoriasis. The condition presents as asymmetric involvement of multiple joints and is difficult to manage with standard therapy. The histologic examination of skin specimens from HIV-infected psoriasis patients classically displays an elevated number of plasma cells (Montazeri et al. 1996).

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