for Health Care Providers
Psoriasis
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| Etiology | Findings/ Distribution | Diagnostic Clues | Management |
|---|---|---|---|
| Activation of lymphocytes causes shortened epidermal life cycle (10 times shorter than normal), leading to epidermal hyperproliferation | Silvery scales on red plaques More common on extensor surfaces In HIV infection, can have unusual distribution, such as inverse psoriasis on palms and on soles of feet | More severe and more difficult to treat in patients with low CD4 cell counts Patients with CD4 counts of <200 cells/µL not on ART can have lesions on >50% of body May see unusual presentations of inverse and diffuse psoriasis Biopsy shows epidermal hyperplasia, parakeratosis, neutrophils, diminished granulosum layer | Clobetasol 0.05% ointment BID OR Calcipotriene topical 0.005% ointment BID Ultraviolet light; narrowband UVB Narrowband UVB and acitretin is more effective than acitretin monotherapy Acitretin 10-25 mg daily; avoid during pregnancy; can cause dyslipidemia Interactions: acitretin + tetracycline carries risk of pseudotumor cerebri; avoid combination In cases of extensive psoriasis, consider initiating ART (or maximizing efficacy of ART) Severe life-threatening psoriasis (pustular psoriasis or erythrodermic disease) requires expert consultation |
Topical steroid relative potency (1 = least potent; 10 = most potent)
| 1 | 4 | 7 | 10 |
|---|---|---|---|
| Hydrocortisone 1% cream/lotion/ointment | Triamcinolone (TAC) 0.1% cream/ointment Alclometasone 0.05% cream/ointment Desonide 0.05% cream/lotion/ ointment | Fluocinonide (Lidex) 0.05% cream/gel/lotion/ ointment | Clobetasol 0.05% cream/gel/ointment/ solution |
From Dermatologic Conditions
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009
