If you have HIV, you may know that you’re at higher risk for other health conditions, such as heart, kidney and liver disease. But did you know you could be more likely to develop psoriasis, too? This skin disease causes itchy, red, scaly patches on your skin. Like HIV, it is a chronic disease with no cure. But unlike HIV, it’s not a virus that causes psoriasis. An immune system problem causes the condition.
When you have psoriasis, an autoimmune disease, you have an overactive immune system. While its usual job is to attack germs and infections, in psoriasis, the immune system attacks you – specifically your skin. It causes your skin cells to replace themselves too quickly, which leads to the inflammation and other symptoms you can see on the skin’s surface.
HIV not only makes you more likely to develop psoriasis, but it can also make the psoriasis more severe than it would be in someone who doesn’t have HIV. Also, your HIV status could put limits on the kinds of medications you can use for psoriasis. That’s because some of the drugs for this skin condition weaken your immune system to make it stop attacking your skin. But you don’t want to further weaken your immune system when you have HIV.
Mild psoriasis, however, is usually manageable. And even if you have more severe disease, there are treatment options available to you. Here’s what you should know.
What’s the Connection?
People with HIV may be up to 80 percent more likely to develop psoriasis than others. It’s not quite clear why people with HIV might be more prone to psoriasis and to more severe cases, but researchers have a few theories. Here are some of their ideas:
An overactive immune system. In people with HIV, certain genes help fight the virus. They do this by activating the immune system. But psoriasis is the result of an overactive immune system. In psoriasis, the immune system is so active that it attacks not only infections, but also healthy cells, including your skin cells. It may be that an immune system activated against HIV becomes more vulnerable to psoriasis.
Fewer disease-fighting cells. People with HIV often have lower levels of disease-fighting cells like T cells. This may leave them more vulnerable to the inflammation that can contribute to psoriasis and make the disease more severe.
A side effect of treatment. Sometimes, HIV treatment (antiretroviral therapy or ART) can lead to immune reconstitution inflammatory syndrome or IRIS. In IRIS, as the immune system – which HIV damages – begins to recover with HIV treatment, your HIV can get better but then other diseases that you might not have known you had before can arise. Psoriasis can be one of them.
Because of the link between HIV and psoriasis, you may develop psoriasis as soon as you contract HIV. For some people, a new case of psoriasis is the first sign they have HIV. For people who already have psoriasis, new infection with HIV can cause a psoriasis flare. As your HIV progresses, your psoriasis may worsen, which can mean progression to psoriatic arthritis. Anywhere from a quarter to half of HIV patients with psoriasis go on to develop psoriatic arthritis, a form of inflammatory arthritis that makes it hard to get around.
How Can I Tell If I Have Psoriasis or Something Else?
The symptoms of psoriasis tend to look the same in people with HIV as they do in anyone else. If you are white, you will have raised, red, inflamed, scaly patches of skin that may be covered with silvery scales. If you are a person of color, rather than red patches, the affected areas may be purple, gray, or dark brown. People with HIV are also more likely to have psoriasis symptoms that appear:
- On the scalp
- On the soles of feet or the palms of their hands
- In crevices, like armpits or under the breasts
You could also see symptoms of other conditions related to psoriasis that people with HIV are more likely to develop.
People with psoriasis who have HIV may be more likely to get a form of psoriasis called sebopsoriasis, a combination of seborrheic dermatitis and psoriasis. You usually get this kind on your face and scalp, and it causes red bumps and slightly oily yellow scales. Yeast infections, which are also more common in people with HIV, can trigger this kind of psoriasis.
About 3 in 10 people with psoriasis eventually develop psoriatic arthritis. But that risk is higher in people who have both psoriasis and HIV. This type of arthritis causes pain and swelling in your joints. In people with HIV, psoriatic arthritis might be more severe than it would be otherwise.
Your primary care doctor or a dermatologist can check your skin and decide if it’s psoriasis. If they are unsure, they can do a skin biopsy.
What Are My Treatment Options?
If you have mild psoriasis, you might be able to get the same treatment that everyone else gets regardless of HIV status.
The first line of defense is topicals. You rub these medications into your skin over the affected area. They include:
Corticosteroids. You typically apply them once or twice a day to help reduce inflammation. Since they can cause side effects such as skin thinning and stretch marks, your doctor will probably recommend that you only use them for a short period of time.
Calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical). These medications come from vitamin D. They slow the growth of skin cells, which helps reduce psoriasis symptoms. They can be used alone or with corticosteroids.
Tar. It prevents the inflammation that causes psoriasis symptoms. Tar-containing products are available without a prescription and come in the form of shampoos, creams, oils, and lotions.
Tazarotene (Tazorac). This is a topical retinoid derived from vitamin A that you can use alone or with a corticosteroid. Unlike anti-aging retinoids, which speed up skin cell production, this kind slows it down.
Calcineurin inhibitors. These include pimecrolimus (Elidel) and tacrolimus (Protopic) creams. They are usually for psoriasis symptoms on the face and in skin folds, like the armpits or under the breasts.
Acitretin (Soriatane). If the above topicals, in combination with other treatments your doctor may recommend, aren’t enough to keep your psoriasis in check, your doctor may prescribe this. It may take 3 to 6 months for you to see the effects.
Your doctor might also recommend other treatments besides topicals. They include other medications and light therapy. These may be some of your other options:
Phototherapy. Also known as ultraviolet light therapy, it takes place in your dermatologist’s office or at home. The idea is that the light slows down the growth of skin cells. If you have only a small patch or patches, you can get light therapy that targets only those areas. For psoriasis that affects a large portion of the entire body, you can get therapy from a full-body light unit.
Highly active antiretroviral therapy (HAART). Studies show that some of the same antiviral drugs your doctor prescribes for your HIV check can also help your psoriasis. Your doctor may want to adjust them to better address both your HIV and psoriasis.
For severe psoriasis, people who don’t have HIV usually take medications, such as methotrexate, that suppress the overactive immune system that causes psoriasis in the first place. Typically, that type of immune-suppressing medication wouldn’t be a good idea for someone who has HIV. Since HIV weakens your immune system, a medication that does the same raises the risk that you’ll get sick from another infection.
But some research suggests that if you are on HAART and still need additional medicine for psoriasis, it may be safe to take one of the following medications for severe psoriasis:
- Biologics like adalimumab (Embrel, Humira), etanercept, infliximab (Remicade), infliximab-abda (Renflexis), infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), and ustekinumab (Stelara)
Studies show that biologics may be the best of these three options. But remember, it’s very important to be on HAART at the same time. It appears to significantly reduce your risk of getting another serious infection.