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June 1997

Acitretin Therapy Is Effective for Psoriasis Associated With Human Immunodeficiency Virus Infection

Author Affiliations

From the Department of Dermatology, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY (Drs Buccheri, Katchen, and Cohen) and the Division of Research, Kaiser Permanente Institute, Oakland, Calif (Dr Karter).

Arch Dermatol. 1997;133(6):711-715. doi:10.1001/archderm.1997.03890420043005


To determine the safety, tolerability, and effectiveness of a newer retinoid, acitretin, as monotherapy for psoriasis associated with human immunodeficiency virus infection (PS-HIV). 

Design:  Pilot investigation.

Setting:  An academic medical center.

Patients:  Eleven patients selected from volunteers with PS-HIV were enrolled in a 20-week treatment protocol. Two patients discontinued participation in the study because of worsening psoriasis; a third patient was unable to continue treatment after having a myocardial infarction, presumably unrelated to acitretin therapy.

Intervention:  Each patient received an optimized dose of acitretin during the period of observation. Clinical and laboratory assessments were performed every 2 weeks during the trial.

Main Outcome Measures:  The Psoriasis Area and Severity Index was used to assess the clinical response to treatment. To monitor for toxic drug effects, a panel of laboratory parameters, including complete blood cell count, biochemistry profile, urinalysis, HLA typing, skin biopsy for histological examination, and T-cell counts, was performed.

Results:  Six (54%) of 11 patients with PS-HIV achieved good to excellent responses using acitretin monotherapy. Four patients (36%) achieved complete clearing. There was no evidence of a correlation between the pretreatment measures of immunosuppression and the therapeutic response. Parameters of immunosuppression were not exacerbated by acitretin therapy. Conclusions: Acitretin is a safe and effective treatment for PS-HIV. Both skin and joint manifestations of PSHIV responded to acitretin therapy in most patients. Optimal results were achieved with a dose of 75 mg/d. The adverse effects were moderate and well tolerated. Acitretin does not appear to have immunosuppressive properties. A formal randomized clinical trial is warranted.Arch Dermatol. 1997;133:711-715