Infect Chemother.  2014 Jun;46(2):115-119. 10.3947/ic.2014.46.2.115.

A Case of Severe HIV-Associated Psoriasis Successfully Treated with Acitretin Therapy

• Jeong YS
• Kim MS
• Shin JH
• Cho JK
• Lee HI
• Kim HJ
• Choi JP

• KMID: 2284989
• DOI: http://doi.org/10.3947/ic.2014.46.2.115

Abstract

Psoriasis is a chronic inflammatory skin disease that involves immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. Psoriasis in patients with HIV responds poorly to treatment and has a high morbidity rate, thus posing a challenge to clinicians. Until now, there have been no documented cases of acitretin therapy for HIV-associated psoriasis in Korea. Here, we report a case of safe and successful therapy with acitretin in a 52-year-old man with HIV-associated psoriasis that responded poorly to previous treatments including steroids and ultraviolet B phototherapy. We also review the relevant literature.

Keyword

Human immunodeficiency virus; Psoriasis; Acitretin

MeSH Terms

Acitretin*
HIV
Humans
Inflammation
Keratinocytes
Korea
Middle Aged
Phototherapy
Psoriasis*
Skin Diseases
Steroids
Acitretin
Steroids

Figure

• 

  Figure 1 Pathologic findings. (A) The epidermis shows irregular acanthosis, partial parakeratosis, and focal microabscesses in the keratin layer (thin arrow). The upper dermis shows perivascular inflammatory cells infiltration (thick arrow) (hematoxylin & eosin, × 10). (B) High-power field, showing, some plasma cells (arrow), mature lymphocytes, and macrophages in the perivascular area (hematoxylin & eosin, × 40).

• 

  Figure 2 Photographs showing symmetrical, erythematous, and scaly plaques cutaneous lesion on the anterior trunk (A) and dorsum (B). On the 8th day of acitretin administration, the scaly lesions on the anterior trunk and dorsum had improved (C, D). After 2 months of treatment, the erythematous and scaly plaque cutaneous lesions nearly disappeared (E, F).

• 

  Figure 3 Treatments administered. Acitretin 30, 20, and 10 mg were administered for 21 weeks. Phototherapy involving 3 courses of ultraviolet B radiation (300-397 mJ) was administered for 6 weeks. Anti-retroviral therapy involving boosted atazanavir and raltegravir was administered throughout the treatment period.

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