How to Treat Psoriasis in HIV Patients
It seems strange that psoriasis, a condition caused by an overactive immune system, can occur in people with human immunodeficiency virus (HIV), a disease that destroys the immune system. Psoriasis occurs in about 3% of people with HIV, though, the same rate as in the general population. It is a chronic condition resulting from an overgrowth of skin cells that forms red, scaly lesions on the skin. Psoriasis is characterized by periodic outbreaks triggered by stress, illness, injury or allergy. Outbreaks tend to be more severe in people with HIV, and severity increases as HIV infection progresses.
Instructions
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Standard Treatment
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Don't rely on standard psoriasis treatments. They may be ineffective for people with HIV.
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Use topical corticosteroid creams and ointments for mild outbreaks.
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Clear skin lesions with phototherapy, which is treatment with ultraviolet (UV) B light and excimer lasers.
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Treat more severe outbreaks with anti-TNF (tumor necrosis factor) inhibitors, such as etanercept (Enbrel) and infliximab (Remicade). Anti-TNF inhibitors require regular injections and may be associated with side effects including tuberculosis and other infections.
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Avoid methotrexate and cyclosporin A. Although these are used to treat psoriasis, they cannot be used for people with HIV infection because they suppress the immune system.
Specialized Treatment
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Slow cell growth and maturation with oral retinoid (acitretin) plus topical retinoid (calcipotriene or tazarotene).
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Control lymphocyte production with UVB light plus topical retinoid (calcipotriene or tazarotene) OR UVB with or without oral retinoid (acitretin) or hydroxyurea (topical vitamin D analog.
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Another treatment to control lymphocyte production is psoralen and UVA light (PUVA). It is used with topical or oral retinoid.
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Ensure patients with HIV and psoriasis continue their highly active antiretroviral therapy (HAART) for HIV infection. Studies have shown HAART effectively controls psoriasis outbreaks, so it is doubly important for patients with HIV and psoriasis to continue their treatment without interruption.
Nonmedical Therapies
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Keep skin moisturized to control the itching that accompanies psoriasis outbreaks.
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Ease discomfort with cold compresses, cool showers, antihistamines, topical corticosteroids and antihistamines.
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Explore alternative therapies. Astragalus, a root used in traditional Chinese medicine, contains the chemical TAT2. Research has shown TAT2 improves the ability of cells to fight off HIV infection. Indigo naturalis, a powder made from plants, is another ingredient used in Chinese medicine to reduce skin scales and redness.
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