What You Should Know About Psoriasis and HIV

Medically reviewed by Steve Kim, MD on January 25, 2016Written by James Roland on January 25, 2016

How Does Psoriasis Relate to HIV?

People with HIV used to have a different outlook than they currently do. The virus often progressed to AIDS, which is the final stage of HIV, and premature death. Advances in medication are now allowing people with HIV to live longer and to remain in general good health.

Having HIV increases the risk of developing several other health conditions. These include kidney disease, cryptococcal meningitis, and certain lymphomas.

Treating these other diseases can be more challenging because of the powerful drugs that people with HIV must take every day. Fears of drug interactions are very real. Because people with HIV already have a compromised immune system, side effects from other drugs can be amplified.

These concerns even extend to psoriasis, a chronic skin condition and autoimmune disease. Psoriasis is especially common in people who have HIV. Psoriasis treatment is more complicated if you also have HIV.

What Is Psoriasis?

Psoriasis causes thick, scaly patches or plaques to appear on the skin. Patches typically develop on the elbows, knees, and back, though they can form anywhere on the body. Patches are created when new skin cells form below the skin and rise to the surface before the dead skin cells are shed.

Psoriasis is an autoimmune disease. That means that 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 then thinks that new, healthy skins cells are needed. This causes production of those cells to speed up in an unhealthy way.

Scientists aren’t completely sure what causes psoriasis. There are some definite triggers for flare-ups, though. These can include:

  • stress
  • smoking
  • cold weather
  • injury to the skin

Infections of any kind can also trigger a psoriasis outbreak. This can make people with HIV more susceptible to psoriasis complications.

How Is Psoriasis Treated in People with HIV?

There’s a wide range of psoriasis treatments. Among them are topical steroid ointments, oral medications, and ultraviolet light B (UVB) therapy. Immunosuppressive medications are of particular concern for people with HIV.

Immunosuppressive drugs are designed to limit the immune system’s response. These medications can be very helpful in minimizing flare-up symptoms in people with autoimmune disorders such as psoriasis or lupus.

HIV weakens the immune system. This is why people with HIV are at greater risk for infections. Taking a drug that further suppresses the immune system is likely to put someone with HIV at even greater risk of an infection.

One of the most common immunosuppressant drugs used is methotrexate. It’s often very helpful in managing flare-ups, but it’s particularly risky for people with both HIV and psoriasis to take it. Topical steroids can also affect the body’s immune system. 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 if you have liver damage caused by hepatitis B this drug may not be a good choice for you.

UVB therapy requires weekly treatments to help reduce psoriatic symptoms. This therapy has had mixed results among people with HIV and psoriasis.

How Is Psoriasis Prevented?

Psoriasis can affect anyone at any age. Because the origins of psoriasis aren’t well understood, there’s really no way to prevent the disease. Instead, the focus is usually to try to reduce the frequency and intensity of flare-ups.

Severe Psoriasis: Managing a Flare-Up

Controlling stress, quitting smoking and taking care of your skin are all ways to at least lower your odds 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.

Speaking with Your Doctor

Whether or not you have HIV, you should see a dermatologist regularly for skin cancer checks. You should also report any symptoms that may look like psoriasis to your dermatologist promptly. If you’re not sure if it’s psoriasis, you should still have your doctor evaluate your symptoms. Skin conditions such as eczema can often be confused with psoriasis.

Early diagnosis may mean that you can treat your condition with milder drugs. You may also be able to undergo a therapy that may not put you at greater risk of infection or complications due to HIV. If your dermatologist is unsure about how psoriasis treatment may affect your HIV, see if you can bring in the doctor who’s overseeing your HIV treatment so that you can meet in a group. Coordinated care may be your best hope at managing these two conditions with a minimum of complications.

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