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Psoriasis

for Health Care Providers

Psoriasis

Back to Dermatologic Conditions Chapter

EtiologyFindings/ DistributionDiagnostic CluesManagement
Activation of lymphocytes causes shortened epidermal life cycle (10 times shorter than normal), leading to epidermal hyperproliferationSilvery 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)

14710
Hydrocortisone 1% cream/lotion/ointmentTriamcinolone (TAC) 0.1% cream/ointment

Alclometasone 0.05% cream/ointment

Desonide 0.05% cream/lotion/ ointment

Fluocinonide (Lidex) 0.05% cream/gel/lotion/ ointmentClobetasol 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