Psoriasis is an inflammatory condition that can lead to skin changes. It is relatively common among people with HIV.
Psoriasis can appear for the first time or worsen after a person contracts HIV. The symptoms can present in the early or late stages of HIV infection.
Both HIV and psoriasis respond to medications, although having both conditions can make it more difficult to treat the symptoms of psoriasis.
In this article, we examine the link between psoriasis and HIV. We also outline the treatments available for people with HIV-associated psoriasis.
HIV is a virus that targets the immune system. It damages or destroys CD4 T cells, which are important for fighting infection and disease.
Without treatment, HIV weakens the immune system, increasing the chance of other illnesses arising. These include psoriasis.
Psoriasis is one of the most common skin-related conditions that affect people with HIV. It most often arises in people with low CD4 T cell counts who are not on effective antiretroviral therapy.
Psoriasis may sometimes arise shortly after a person begins antiretroviral therapy. In such cases, it is known as an immune reconstitution inflammatory syndrome (IRIS).
IRIS affects up to 20% of people when they begin antiretroviral therapy.
Antiretroviral therapy may lead to psoriasis as a result of an overactive immune system. Antiretroviral drugs improve the activity of the immune system, which can make psoriasis more likely to arise.
However, in many people, antiretroviral therapy causes psoriasis to subside as the immune system response becomes stronger.
Many drugs that treat psoriasis suppress the immune system, which makes them less suitable for people with HIV.
The Centers for Disease Control and Prevention (CDC) recommend antiretroviral therapy for everyone with HIV, regardless of their current health. With consistent use, this treatment helps by:
- improving the immune system
- minimizing the risk of opportunistic infections and other HIV-related complications
- slowing or halting the progression of the virus in the body
- preventing HIV from reaching an advanced stage
- preventing the transmission of the virus to other people
Once the levels of the virus in a person’s blood become undetectable in tests, HIV is untransmittable through sexual contact.
In many cases, HIV medications can also ease psoriasis symptoms.
According to research, people with HIV and psoriasis will typically see improvements in their skin symptoms after beginning antiretroviral therapy.
Managing psoriasis in people with HIV can be challenging for healthcare professionals.
The reason for this is that some treatments for severe psoriasis, known as systemic treatments, suppress the immune system. HIV already suppresses a person’s immune system, making it more likely that they will experience infections.
However, a 2018 review of existing research on systemic treatments of severe psoriasis in people with HIV found that some doctors have used them with some success.
That said, researchers have not studied these drugs in any human drug trials. People should speak with a doctor before using any systemic drug treatments.
Topical therapy can help treat mild-to-moderate psoriasis. This treatment may include creams, lotions, and ointments, such as hydrocortisone or triamcinolone.
UV light therapy and oral retinoids, such as acitretin, can help with mild-to-severe psoriasis.
An individual will need to work with their healthcare provider to determine the best treatment plan for their situation.
People cannot prevent psoriasis from occurring, but they can minimize the frequency of psoriasis flares by avoiding triggers.
The genetics behind the development of psoriasis are complex. A triggering event can cause a change in the immune system, leading to the development of psoriasis. Common triggers include illness, stress, skin injuries, and some medications.
In those who already have psoriasis, avoiding known triggers can reduce the number and severity of flares.
Psoriasis triggers may include:
- food allergies
- heavy alcohol use
- infections that weaken the immune system, including strep throat, bronchitis, and tonsillitis
- nutrient deficiencies, such as vitamin D deficiency
- skin damage, such as from bug bites, sunburn, or picking at the skin
- stress and anxiety
- the use of specific medications, including drugs for malaria, high blood pressure, and bipolar disorder
- changes in the weather
The symptoms vary from person to person and depend on the type of psoriasis.
However, psoriasis typically causes:
- inflamed patches with silvery scales
- dry skin
- skin that cracks and bleeds
- thick nails or nails that develop ridges
Psoriasis may have an unusual distribution in people with HIV. For example, they may have inverse psoriasis on the palms or soles, even though this type of psoriasis usually affects skin folds, such as the armpits or groin.
Psoriasis can be severe in people with low CD4 T cell counts who are not on effective antiretroviral therapy, covering more than 50% of the body.
In addition to skin symptoms, some people with psoriasis develop swollen, painful joints, which is known as psoriatic arthritis.
Psoriasis signs and symptoms may flare up for several weeks or months at a time before improving or going away for a period, which is known as remission.
Psoriasis is not contagious. People cannot contract psoriasis by touching someone with the condition or by sharing their towels or personal care items.
Psoriasis is an autoimmune condition, which means that it arises when the immune system mistakenly attacks the skin cells. The body then begins to speed up the rate at which new skin cells form, which causes the scales and patches that characterize psoriasis.
The first- and second-line treatments for psoriasis, which may also be beneficial for people with HIV-associated psoriasis, include:
Skin creams and ointments can be effective for mild-to-moderate cases of psoriasis. Some are available over-the-counter, while others may require a prescription. Options include:
- antibacterial soaps
- calcineurin inhibitors for inflammation
- coal tar
- corticosteroid creams
- moisturizing lotions
- salicylic acid
- synthetic vitamin D creams
- topical retinoid medications
This form of light therapy uses UV light to reduce lesions. Phototherapy can cause side effects that include dry skin and nausea.
In addition to avoiding psoriasis triggers, the following may reduce psoriasis symptoms and alleviate discomfort:
- applying aloe vera gel to affected areas of the skin
- putting coconut oil on the skin
- taking omega-3 supplements
- applying moisturizing lotion daily
- having lukewarm baths with colloidal oatmeal or Epsom salts
Several other skin conditions, which are often types of opportunistic infections, are common in people with HIV. These conditions include:
- Candidiasis: A fungal infection of the skin, nails, and mucous membranes.
- Cryptococcosis: A fungal infection that may affect the skin, bones, lungs, and urinary tract.
- Herpes simplex virus: A virus that causes recurrent sores around the mouth or genitals.
- Molluscum contagiosum: A contagious viral infection that causes flesh-colored bumps to appear on the skin.
- Photodermatitis: An inflammatory condition in which sun exposure causes rashes, blisters, or scaly skin.
- Prurigo nodularis: A condition that causes itchy, crusty lumps on the arms and legs.
- Kaposi sarcoma: A cancer that appears as purple or black skin lesions due to tumors in the blood vessels.
Psoriasis and other skin conditions are common among people with HIV. With proper care and treatment, people can manage their skin symptoms and reduce their discomfort.
Although HIV can make it more challenging to treat psoriasis, research indicates that people typically see improvements after using antiretroviral therapies. A person can also ease the symptoms by avoiding known triggers and using home remedies and medicated creams.
In some cases, a healthcare professional may recommend systemic medications, but this is not appropriate in all cases.
Anyone who has concerns about their skin should see their healthcare provider for an evaluation and diagnosis. Early intervention may improve their outlook and reduce the risk of complications.