Management and prevention

Spontaneous remission to complete unresponsiveness to all therapy has been described for HIV-related psoriasis. Topical therapy includes tar products, emollients, salicylic acid, corticosteroids and retinoids. Traditional systemic therapies such as acitretin (0.5-1 mg/kg) are also used. Methotrexate, although commonly used in the non-HIV psoriatic population, is not commonly used because of its immune modulating effects and increased toxicity in the folate metabolic pathway with diminished renal excretion in many HIV patients also taking trimethoprim/sulfamethoxazole. Cyclosporine can be prescribed at 2·5 mg/kg per day, but careful monitoring of the drug trough concentration is recommended. Cyclosporine is recommended for short intermittent courses of up to 12 weeks. It can also be used when rapid remission is needed in potentially lethal psoriasis variants such as erythroderma or generalised pustular psoriasis.[153]  The use of UV light therapy is debated.[154]  Biologics are being increasingly used for psoriasis and, although there are limited reports, antitumour necrosis factor therapy has been used with success in patients with HIV infection with progressive psoriatic arthritis.[155]  the safety profile of the biologic therapies has yet to be determined in the context of HIV infection.