Dramatic Cutaneous Psoriasis Improvement in a Patient With the Human Immunodeficiency Virus Treated With 2',3'-Dideoxycytidine and Ritonavir

Abstract

Psoriasis is particularly severe and difficult to treat using conventional therapy in patients with the human immunodeficiency virus (HIV).¹Zidovudine has already been shown to be of benefit for the treatment of psoriasis in patients with HIV,²but to our knowledge, no other antiretroviral agent has been reported to have this particular activity. We describe a 43-year-old intravenous drug abuser who since 1986 developed severe psoriasis involving 6 sites (face, umbilicus, fingers and nails, elbows, buttocks, and knees), with a global body surface area of 20%, accompanied by painful arthritis involving the wrists, fingers, and ankles. The diagnosis of psoriasis was made by a dermatologist and confirmed on a skin biopsy specimen with fungal stain. At that time the patient's HIV-positive status was discovered (enzyme-linked immunosorbent assay and Western blot technique). Despite treatment with methotrexate (7.5 mg/wk for 1 month), which was rapidly discontinued because of patient intolerance,