REPORT OF CASE
In January 1989, a 28-year-old black man severely affected with the acquired immunodeficiency syndrome developed diffuse psoriasiform lesions characterized by welldemarcated, erythematous plaques with adherent silvery scale, predominantly involving the trunk (Fig 1) and the extensor surfaces of the extremities. Punch biopsy was performed, and the specimen was stained with Leder stain (chloroacetate esterase) that showed regular acanthosis with clubbed rete ridges, confluent parakeratosis, and a perivascular infiltrate of lymphocytes and mast cells (Figs 2 and 3). The patient had no family history of psoriasis.In September 1989, a regimen of oral zidovudine (500 mg/d) and aerosolized pentamidine (300 mg/mo) was started. Throughout the course of his disease, these medications did not affect his psoriatic lesions. In the 18 months following the development of psoriasis, multiple topical medications including tar, anthralin, and potent corticosteroids were tried but did not result in improvement of the lesions.
THERAPEUTIC CHALLENGE