Choosing a treatment modality for psoriasis in HIV-infected patients can be quite a difficult task for dermatologists. These physicians may be reluctant to treat HIV-infected patients with immunosuppressive agents when the host is already immunologically compromised. The available data on safety and efficacy for various psoriasis treatment options in HIV-infected individuals are very limited; yet it is still a physician's duty to provide the best possible treatment for these patients. A revised algorithm is proposed for the treatment of HIV-infected patients with psoriasis based on a previous recommendation from the medical advisory board of the National Psoriasis Foundation. For psoriasis in HIV-infected persons, good HIV control should be the mainstay of treatment. The use of hydroxyurea is reintroduced as an option to consider before the use of systemic immunosuppressant agents. In addition, tumor necrosis factor-α inhibitors may be considered over the oral systemic immunosuppressive agents.
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