Romaní J, Puig L, Baselga E, De Moragas J M
Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Int J Dermatol. 1996 Jul;35(7):484-8. doi: 10.1111/j.1365-4362.1996.tb01661.x.
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.
银屑病样皮炎在HIV感染患者中的患病率与普通人群相似，但其临床严重程度以及这些患者的免疫抑制状况给治疗管理带来了特殊问题。此外，在某些病例中已报告有独特的临床模式。为了评估我们临床环境中的这些特征，我们对所有需要全身治疗的银屑病样皮炎的人类免疫缺陷病毒（HIV）阳性患者的临床记录进行了回顾性研究。
回顾了1988年至1994年间因银屑病样皮炎从HIV诊所转诊至大学医院皮肤科的7例HIV阳性患者的临床记录，这些患者的银屑病样皮炎对局部治疗耐药。
临床表现相当一致，具有以下共同特征：面部脂溢性皮炎、屈侧和肢端受累、掌跖脓疱病以及频繁的关节炎。皮损出现在获得性免疫缺陷综合征（AIDS）的非终末期。3例患者在诊断HIV感染后出现皮肤病变，表现出最严重的临床受累和关节炎。依曲替酯，其次是补骨脂素联合紫外线A（RePUVA），被证明是最有效的全身治疗方法，不良反应罕见。甲氨蝶呤显示有效，但使用时伴有血液学毒性。环孢素A治疗效果中等，且与AIDS进展无关。
在AIDS相关的银屑病样皮炎中观察到类似赖特尔综合征的特征性临床表现。依曲替酯和RePUVA在控制皮损方面有效且安全。AIDS相关银屑病发生发展中涉及的生理病理机制可能为这些患者临床模式的显著相似性提供解释。
