Reiter's syndrome-like pattern in AIDS-associated psoriasiform dermatitis

The prevalence of psoriasiform dermatitis in HIV-infected patients is similar to that in the general population, but its clinical severity and the immunosuppression in these patients pose special problems of therapeutic management. Furthermore, a distinctive clinical pattern has been reported in some cases. In order to assess these features in our clinical setting, we have done a retrospective study on the clinical records of all human immunodeficiency virus (HIV)-positive patients with psoriasiform dermatitis requiring systemic treatment.

The clinical records were reviewed of seven HIV-positive patients who were referred between 1988 and 1994 to a University Hospital Dermatology Department from an HIV-clinic because of psoriasiform dermatitis, resistant to topical treatment.

The clinical appearance was rather uniform, with the following common features: facial seborrhea, flexural and acral involvement, with pustulosis of the palms and soles, and frequent arthritis. Lesions appeared in nonterminal stages of acquired immunodeficiency syndrome (AIDS). Three patients developed cutaneous lesions after the diagnosis of HIV infection was made and showed the most severe clinical involvement and arthritis. Etretinate, followed by RePUVA, proved to be the most effective systemic therapy prescribed, with only rare adverse effects. Methotrexate was shown to be effective, but it's use was accompanied by hematologic toxicity. Cyclosporine A treatment was moderately effective and was not associated with progression of AIDS.

A characteristic Reiter-like clinical picture was observed in AIDS-related psoriasiform dermatitis. Etretinate and RePUVA were effective and safe in controlling the lesions. Physiopathologic mechanisms involved in the development of AIDS-related psoriasis might provide an explanation for the outstanding similarity of the clinical pattern in those patients.