Clinical and Experimental Dermatology 1992; 17: 342-343,
The use of calcipotriol in HIV-related psoriasis J.D.GRAY, W.IJOTTOMLEY, A.M.LAYTON, J.A.COTTERILL AND E.MONTEIRO* Departments of Dermatology and *Genito~urinary Medtctne, The General Infirmary at Leeds, Great George Street,
Sl 3EX, UK Accepted for publication 18 November 1991
Summary
biopsy showed diminished erythropoiesis consistent with zidovudine toxicity, but no evidence of opportunistic We report the case of a 28-year-old homosexual man with infection or lymphoma. The zidovudine was discontiadvanced HIV disease (CDC classification group IV A) nued without apparent deterioration in the psoriasis. who developed erythrodermic psoriasis which responded Etretinate 75 mg/da> was commenced. After 5 weeks to calcipotriol, a topical vitamin D analogue. We believe this to be the first reported case of HTV-related psoriasis treatment with etretinate there was minimal improveresponsive to this form of treatment. Systemic therapy for ment in the psoriasis. The skin remained sore and HTV-rclated psoriasis is limited because of immunosup- extoliative and he still had a swinging fever. Apart from a pressive effects. We suggest that calcipotriol may prove to localized abscess on the buttock which responded to antibiotics, no source of infection could be identified be a useful therapeutic option in these patients. despite extensive investigation. Topical calcipotriol was started once daily in conjunction with the etretinate. About 30 g calcipotriol per day were necessary. Within a few days there was a marked improvement in the psoriasis. He felt systemically much better once his skin Case report improved, was able to mobilize and was discharged home A 28-ycar-oid male homosexual was diagnosed as being on the etretinate and topical calcipotriol. 1 here was no HIV-positive in 1987. In August 1989 he developed alteration in serum calcium. Since finishing the recomwidespread small plaque-type psoriatic lesions which mended 6-week course of calcipotriol, the psoriasis has quickly cleared using in-patient treatment with the remained well controlled on etretinate 75 mg daily. Ingram dithranol regime. He was already taking zidovudine 250 mg b.i.d. as he had AIDS-related complex. In December 1990 the psoriasis flared again. His CD4 count Discussion was 70 X lOVl. Initially there were multiple small plaques on extensor surfaces but these progressed becoming The incidence of psoriasis in TllV-positive patients is not confluent over large areas. Treatment with PUVA was increased. However, it is often more severe and may initiated three times weekly using 2 0 J/cm^ increasing to prove refractory to conventional therapies.' Many ofthe a maximum of 3 0 J/cni". Despite the low doses of PUVA systemic therapies used for psoriasis are contra-indicated this resulted in a degree of burning. On stopping the in HIV-related psoriasis because ofthe immunosuppresPUVA the psoriasis deteriorated and progressed to an sive effects. This case illustrates the benefit of calcipotriol erythrodermic phase. The patient was systemically in this refractory form of psoriasis. unwell with fever and rigors and required admission to The severity of psoriasis often correlates with the hospital. Subsequent therapy included treatment with immune status. Patients with CD4 counts of > 400 x lO''/! eosin and ichthammol, Lassar's paste, emollients and often have mild disease compared to those with CD4 potent topical steroids. All these therapeutic measures counts of , 5, Dicz F, del IIo\o M, Serrano S. Zidovudine treatment of psoriasis associated with aquired immunodeficiency syndrome. Journal of the American Academy of Dermatology 1990; 22(1): 146-147. 6, Belz J, Breneman DL, Xordlund JJ et al. Successful treatment of a man uith Reiter's syndrome and aquired immLinodeficiency syndrome using etretinate. Journal of rhe American Academy of Dermatology 1989; 20: 898-903, 7, Wilhams lIC, Du Vivier AW. Etretinate and AIDS-relatcd Reiter's disea,se, British Journal of Dermatology 1991' 124- ^89392, ' ^ . • 8, Valerie K, Delers A, Bruck C et al. Activation of human immunodeficiency virus T>pe 1 by D \ A damage in human cells Nature 1988; 3.13: 78-81, 9, Johnson IWI, Duvic M, Rapini RP et al. AIDS exacerbates psoriasis. New England Journal of Medicine 1985; 313; 1415, 10, Layton AM, Sheehan-Dare RA, Goodfield MJ et al. Hydrox>urea m the management of therapy resistant psoriasis. British Journal of Dermatology ]989; 121: 647-653, 11, Dahl MG, Comaish JS. Long term effects of Hydrox>urea in p-soriasis, British Medical Journal 1972; 4: 585-587, 12, Baker H, Ryan TJ. Generalized pustular psoriasis. British Journal of Dermatology 1968; 80: 771-793. 13, Binderup L, Bramm E. Effects of a novel vitamin D analogue (MC 903) on cell proliferation and differentiation in vitro and on calcium metaholism in vivo. Biochemical Pharmacology 1988- 37" 889-895. ' ' 14, Kraghalie K. MC 903, a non-calciotropic vitamin D analogue stimulates differentiation and inhibits proliferation of eultured human keratinocytes. Journal of Investigative Dermatology 198891: 383. " 15, Kraghalie K, Beck HI, Sogaard H. Improvement of psoriasis by a topical vitamin m analogue (MC 903) in a double-blind study. British Journal of Dertnatology 1988; 119: 223 230. 16, Kragballe K. Treatment of psoriasis by the topical application of the novel cholecalciferol analogue calcipotriol (MC 903). Archives of Dermatology 1989; 125: 1647-1652.
The use of calcipotriol in HIV-related psoriasis J.D.GRAY, W.IJOTTOMLEY, A.M.LAYTON, J.A.COTTERILL AND E.MONTEIRO* Departments of Dermatology and *Genito~urinary Medtctne, The General Infirmary at Leeds, Great George Street,
Sl 3EX, UK Accepted for publication 18 November 1991
Summary
biopsy showed diminished erythropoiesis consistent with zidovudine toxicity, but no evidence of opportunistic We report the case of a 28-year-old homosexual man with infection or lymphoma. The zidovudine was discontiadvanced HIV disease (CDC classification group IV A) nued without apparent deterioration in the psoriasis. who developed erythrodermic psoriasis which responded Etretinate 75 mg/da> was commenced. After 5 weeks to calcipotriol, a topical vitamin D analogue. We believe this to be the first reported case of HTV-related psoriasis treatment with etretinate there was minimal improveresponsive to this form of treatment. Systemic therapy for ment in the psoriasis. The skin remained sore and HTV-rclated psoriasis is limited because of immunosup- extoliative and he still had a swinging fever. Apart from a pressive effects. We suggest that calcipotriol may prove to localized abscess on the buttock which responded to antibiotics, no source of infection could be identified be a useful therapeutic option in these patients. despite extensive investigation. Topical calcipotriol was started once daily in conjunction with the etretinate. About 30 g calcipotriol per day were necessary. Within a few days there was a marked improvement in the psoriasis. He felt systemically much better once his skin Case report improved, was able to mobilize and was discharged home A 28-ycar-oid male homosexual was diagnosed as being on the etretinate and topical calcipotriol. 1 here was no HIV-positive in 1987. In August 1989 he developed alteration in serum calcium. Since finishing the recomwidespread small plaque-type psoriatic lesions which mended 6-week course of calcipotriol, the psoriasis has quickly cleared using in-patient treatment with the remained well controlled on etretinate 75 mg daily. Ingram dithranol regime. He was already taking zidovudine 250 mg b.i.d. as he had AIDS-related complex. In December 1990 the psoriasis flared again. His CD4 count Discussion was 70 X lOVl. Initially there were multiple small plaques on extensor surfaces but these progressed becoming The incidence of psoriasis in TllV-positive patients is not confluent over large areas. Treatment with PUVA was increased. However, it is often more severe and may initiated three times weekly using 2 0 J/cm^ increasing to prove refractory to conventional therapies.' Many ofthe a maximum of 3 0 J/cni". Despite the low doses of PUVA systemic therapies used for psoriasis are contra-indicated this resulted in a degree of burning. On stopping the in HIV-related psoriasis because ofthe immunosuppresPUVA the psoriasis deteriorated and progressed to an sive effects. This case illustrates the benefit of calcipotriol erythrodermic phase. The patient was systemically in this refractory form of psoriasis. unwell with fever and rigors and required admission to The severity of psoriasis often correlates with the hospital. Subsequent therapy included treatment with immune status. Patients with CD4 counts of > 400 x lO''/! eosin and ichthammol, Lassar's paste, emollients and often have mild disease compared to those with CD4 potent topical steroids. All these therapeutic measures counts of , 5, Dicz F, del IIo\o M, Serrano S. Zidovudine treatment of psoriasis associated with aquired immunodeficiency syndrome. Journal of the American Academy of Dermatology 1990; 22(1): 146-147. 6, Belz J, Breneman DL, Xordlund JJ et al. Successful treatment of a man uith Reiter's syndrome and aquired immLinodeficiency syndrome using etretinate. Journal of rhe American Academy of Dermatology 1989; 20: 898-903, 7, Wilhams lIC, Du Vivier AW. Etretinate and AIDS-relatcd Reiter's disea,se, British Journal of Dermatology 1991' 124- ^89392, ' ^ . • 8, Valerie K, Delers A, Bruck C et al. Activation of human immunodeficiency virus T>pe 1 by D \ A damage in human cells Nature 1988; 3.13: 78-81, 9, Johnson IWI, Duvic M, Rapini RP et al. AIDS exacerbates psoriasis. New England Journal of Medicine 1985; 313; 1415, 10, Layton AM, Sheehan-Dare RA, Goodfield MJ et al. Hydrox>urea m the management of therapy resistant psoriasis. British Journal of Dermatology ]989; 121: 647-653, 11, Dahl MG, Comaish JS. Long term effects of Hydrox>urea in p-soriasis, British Medical Journal 1972; 4: 585-587, 12, Baker H, Ryan TJ. Generalized pustular psoriasis. British Journal of Dermatology 1968; 80: 771-793. 13, Binderup L, Bramm E. Effects of a novel vitamin D analogue (MC 903) on cell proliferation and differentiation in vitro and on calcium metaholism in vivo. Biochemical Pharmacology 1988- 37" 889-895. ' ' 14, Kraghalie K. MC 903, a non-calciotropic vitamin D analogue stimulates differentiation and inhibits proliferation of eultured human keratinocytes. Journal of Investigative Dermatology 198891: 383. " 15, Kraghalie K, Beck HI, Sogaard H. Improvement of psoriasis by a topical vitamin m analogue (MC 903) in a double-blind study. British Journal of Dertnatology 1988; 119: 223 230. 16, Kragballe K. Treatment of psoriasis by the topical application of the novel cholecalciferol analogue calcipotriol (MC 903). Archives of Dermatology 1989; 125: 1647-1652.
