HIV-associated psoriasis: pathogenesis, clinical features, and management
ABSTRACT Psoriasis is a chronic papulosquamous skin disease that is thought to be a T-cell-mediated autoimmune disorder of keratinocyte proliferation. The association between psoriasis and HIV infection seems paradoxical, but insights into the role of T-cell subsets, autoimmunity, genetic susceptibility, and infections associated with immune dysregulation might clarify our understanding of the pathogenesis of psoriasis with HIV in general. HIV-associated psoriasis can be clinically confusing because several comorbid skin disorders in patients with HIV can mimic psoriasis. Phenotypic variants such as a Reiter's syndrome or fulminant erythroderma provide diagnostic clues to underlying immunodeficiency. The management of moderate and severe HIV-associated psoriasis is challenging, although patients typically improve with highly active antiretroviral therapy. Conventional systemic treatments might be contraindicated or need dose adjustment to avoid toxicity. New biological treatments in this setting are promising and warrant further study.
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ABSTRACT: RESUMEN La psoriasis es una enfermedad inflamatoria sistémica crónica que afecta la piel, las mucosas, las uñas y en algunos casos las articulacio-nes; en estudios actuales se afirma que además tiene importantes implicaciones metabólicas. Hasta hace algunos años se consideraba que la psoriasis en los adultos no afectaba la cara o, bien, que era leve y poco frecuente; sin embargo, en diversos estudios se ha corro-borado que es más común de lo que se esperaba y que es un marcador de psoriasis severa. Cuando las lesiones aparecen en la región centrofacial no es fácil realizar el diagnóstico diferencial con dermatitis seborreica, por lo que en algunos casos se utiliza el término de sebopsoriasis. Se comunica el caso de un paciente de 31 años de edad con diagnóstico de psoriasis centrofacial que recibió tratamiento con ungüento de tacrolimus a 0.1%. Las lesiones se aliviaron en tres semanas. Palabras clave: psoriasis facial, centrofacial, sebopsoriasis, tacrolimus. ABSTRACT Psoriasis is a chronic inflammatory systemic disease that may affect skin, mucous membranes, nails and joints. Recent data indicate that psoriasis is also associated with metabolic disorders. Until recently it was considered that facial psoriasis was infrequent, but now it has been reported that facial involvement is more common than previously thought and that is a marker of severe psoriasis. When lesions occur in the central aspect of the face, a differential diagnosis of seborrheic dermatitis is not easy; in this case is correct to use the term sebopsoriasis. We report the case of a 31 year-old male patient with centrofacial psoriasis who was treated with 0.1% topic tacrolimus twice daily, showing relieve of lesions after 3 weeks.
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ABSTRACT: Human immunodeficiency virus (HIV) type 1 dysregulates γδ T cells as part of an immune evasion mechanism. Nearly three decades of research defined the effects of HIV on γδ T cells and how this impacts disease. With highly effective antiretroviral therapy providing virus suppression and longer survival, we expected a return to normal for γδ T cells. This is not the case. Even in patients with CD4 T cell reconstitution, normal γδ T cell levels and function are not recovered. The durable damage to Vδ2 T cells is paralleled by defects in NK, CD8 T cells, and dendritic cells. Whether these consequences of HIV stem from similar or distinct mechanisms are not known and effective means for recovering the full range of cellular immunity have not been discovered. These unanswered questions receive too little attention in the overall program of efforts to cure HIV this disease. Approved drugs capable of increasing Vδ2 T cell function are being tested in clinical trials for cancer and hold promise for restoring normal function in patients with HIV disease. The impetus for conducting clinical trials will come from understanding the significance of γδ T cells in HIV disease and what might be gained from targeted immunotherapy. This review traces the history and current progress of AIDS-related research on γδ T cells. We emphasize the damage to γδ T cells that persists despite effective virus suppression. These chronic immune deficits may be linked to the comorbidities of AIDS (cancer, cardiovascular disease, metabolic disease, and others) and will hinder efforts to eradicate HIV by cytotoxic T or NK cell killing. Here, we focus on one subset of T cells that may be critical in the pathogenesis of HIV and an attractive target for new immune-based therapies.Frontiers in Immunology 01/2014; 5:687. DOI:10.3389/fimmu.2014.00687
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ABSTRACT: Increased understanding of the pathogenesis of immune-mediated neurologic conditions with concomitant development of new therapeutic agents modulating various aspects of the immune system has resulted in the use of innovative therapies in the treatment of these diseases. These novel immunomodulatory therapeutic regimens also augment the potential for complications, including severe adverse effects.In this review, the authors address practical issues regarding management of patients with neuroimmunological conditions treated with immunomodulatory therapies, including glucocorticoids, methotrexate, azathioprine, mycophenolate, cyclophosphamide, rituximab, tumor necrosis factor-α inhibitors, and intravenous immunoglobulins. Particular focus is placed on their infectious and noninfectious adverse effects, contraindications, safety monitoring, risk surveillance, and preventive strategies in clinical practice.Seminars in Neurology 09/2014; 34(4):467-78. DOI:10.1055/s-0034-1390395