The outlook for people with HIV has changed. In the past, HIV often progressed to AIDS, the result of damage done by the virus, which resulted in premature death. Advances in medication are now allowing people with HIV to live longer and remain in general good health.
Treating these other conditions can be more challenging because of the powerful drugs people with HIV must take every day. These may interact with medications used to treat another condition. And people with HIV already have a weakened immune system, so side effects from other drugs can be amplified.
These concerns can extend to psoriasis, a chronic skin condition and autoimmune disease. Psoriasis is especially common in people who have HIV. And for people with both conditions, treatment is more complicated.
Psoriasis causes thick, scaly patches or plaques to appear on the skin. Patches can form anywhere on the body, but typically they develop on the elbows, knees, and back. Patches are created when new skin cells form below the skin and rise to the surface before the dead skin cells above them are shed.
Psoriasis is an autoimmune disease. That means the body’s immune system is performing abnormally. In the case of psoriasis, the immune system may mistakenly attack healthy skin cells in the same way it would an infection. The body thinks it needs new, healthy skins cells. This causes production of new cells to speed up in an unhealthy way.
Scientists aren’t completely sure what causes psoriasis, but they suspect genetics. There are also some triggers for flare-ups. These can include:
Infections of any kind can also trigger a psoriasis outbreak. This can make people with HIV more susceptible to psoriasis complications.
There’s a range of psoriasis treatments. Among them are topical steroid ointments, oral medications, and ultraviolet light B (UVB) therapy. There are also immunosuppressive medications.
Immunosuppressive drugs are designed to limit immune system response. These medications can be very helpful in minimizing flare-up symptoms in people with autoimmune disorders such as psoriasis or lupus.
One of the most common immunosuppressant drugs used is methotrexate. It’s often very helpful in managing flare-ups, but it may not be a good idea for people with both HIV and psoriasis. Taking a drug that further suppresses the immune system is likely to increase the risk of infection for someone with HIV.
Topical steroids can also affect the body’s immune system and help treat psoriasis. This is especially true when the cream is applied to large areas of the body.
Retinoids are effective at clearing up the skin and may be tolerated well by those with HIV. A retinoid called etretinate has had good results in studies. It’s worth noting that this drug may not be a good choice for those who have liver damage caused by hepatitis B.
UVB therapy requires weekly treatments to help reduce psoriatic symptoms. This therapy has had mixed results among people with both HIV and psoriasis.
Psoriasis can affect anyone at any age. Because the origins of psoriasis aren’t well understood, there’s no way to prevent someone from developing the disease. Instead, the focus is usually to try to reduce the frequency and intensity of flare-ups.
Controlling stress, quitting smoking, and taking care of the skin are all ways to lower the risk of a flare-up. Skin care should include keeping it clean, using a moisturizer, and avoiding activities that may cause damage, such as sunburn or scrapes.
See a dermatologist regularly for skin cancer checks, whether you have HIV or not. Also report any symptoms that may look like psoriasis so a doctor can evaluate those symptoms. Skin conditions such as eczema can often be confused with psoriasis.
Early diagnosis may mean that psoriasis can be treated with milder drugs. It may also allow the doctor to recommend a therapy that won’t increase the risk of infection or complications due to HIV.
Some dermatologists may be unsure how psoriasis treatment might affect their patients who have HIV. Those people might want to ask the doctor who’s overseeing their HIV treatment for advice. Coordinated care may be the best hope at managing these two conditions with a minimum of complications.