Hydroxyurea is a drug that has been long forgotten for the treatment of psoriasis. In addition to its anti-psoriatic effects, it has also been shown to have antiviral effects. This dual effect makes it a drug that dermatologists may want to consider when treating psoriasis in HIV-infected patients. Currently, no studies are available that discuss the safety and efficacy of hydroxyurea in the treatment of psoriasis in this immunocompromised group; however, numerous reports discuss the safety and efficacy of hydroxyurea in psoriasis and HIV separately. This review suggests that hydroxyurea is generally safe and effective. The main risk involves the hematologic adverse events (anemia, leukopenia, thrombocytopenia, and macrocytosis), which appear to be dose dependent. Because of the common hematologic adverse events, hydroxyurea may be considered a viable therapeutic option for patients with generalized psoriasis that is inadequately responsive to other safer options, whether or not the patient is HIV positive.
GarbeC., HusakR., OrfanosC.E.HIV-associated dermatoses and their prevalence in 456 HIV-infected patients. Relation to immune status and its importance as a diagnostic marker. Hautarzt.1994; 45(9): 623–9.
MontazeriA., KanitakisJ., BazexJ.Psoriasis and HIV infection. Int J Dermatol.1996; 35(7): 475–9.
4.
MenonK., Van VoorheesA.S., BeboB.F.Jr.; National Psoriasis Foundation. Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol.2010; 62(2): 291–9.
5.
LeavellU.W.Jr., YarbroJ.W.Hydroxy urea. A new treatment for psoriasis. Arch Dermatol.1970; 102(2): 144–50.
6.
RostenM.Hydroxyurea: a new antimetabolite in the treatment of psoriasis. Br J Dermatol.1971; 85(2): 177–81.
7.
HunterG.A., SimmonsI.J., ThomasB.M.A clinical trial of hydroxyurea for psoriasis. Australas J Dermatol.1972; 13(3): 93–9.
8.
DahlM.G., ComaishJ.S.Long-term effects of hydroxyurea in psoriases. BMJ.1972; 4(5840): 585–7.
9.
LaytonA.M., Sheehan-DareR.A., GoodfieldM.J., CotterillJ.A.Hydroxyurea in the management of therapy resistant psoriasis. Br J Dermatol.1989; 121(5): 647–53.
10.
MoschellaS.L., GreenwaldM.A.Psoriasis with hydroxyurea: an 18-month study of 60 patients. Arch Dermatol.1973; 107(3): 363–8.
11.
KumarB., SaraswatA., KaurI.Rediscovering hydroxyurea: its role in recalcitrant psoriasis. Int J Dermatol.2001; 40(8): 530–4.
12.
RanjanN., SharmaN.L., ShankerV., MahajanV.K., TegtaG.R.Methotrexate versus hydroxycarbamide (hydroxyurea) as a weekly dose to treat moderate-to-severe chronic plaque psoriasis: a comparative study. J Dermatolog Treat.2007; 18(5): 295–300.
13.
GiaccaM., ZanussiS., ComarM.Treatment of human immunodeficiency virus infection with hydroxyurea: virologic and clinical evaluation. J Infect Dis.1996; 174(1): 204–9.
LoriF., PollardR.B., WhitmanL.Lowering the dose of hydroxyurea minimizes toxicity and maximizes anti-HIV potency. AIDS Res Hum Retroviruses.2005; 21(4): 263–72.
16.
RutschmannO.T., OpravilM., ItenA.A placebo-controlled trial of didanosine plus stavudine, with and without hydroxyurea, for HIV infection. The Swiss HIV Cohort Study. AIDS.1998; 12(8): F71–7.
17.
HavlirD.V., GilbertP.B., BennettK.; ACTG 5025 Study Group. Effects of treatment intensification with hydroxyurea in HIV-infected patients with virologic suppression. AIDS.2001; 15(11): 1379–88.
18.
LafeuilladeA., HittingerG., ChadapaudS., MaillefetS., RieuA., PoggiC.The HYDILE trial: efficacy and tolerance of a quadruple combination of reverse transcriptase inhibitors versus the same regimen plus hydroxyurea or hydroxyurea and interleukin-2 in HIV-infected patients failing protease inhibitor-based combinations. HIV Clin Trials.2002; 3(4): 263–71.
19.
FrankI., BoschR.J., FiscusS.; ACTG 307 Protocol Team. Activity, safety, and immunological effects of hydroxyurea added to didanosine in antiretroviral-naive and experienced HIV type 1-infected subjects: a randomized, placebo-controlled trial, ACTG 307. AIDS Res Hum Retroviruses.2004; 20(9): 916–26.
20.
MalhotraU., BoschR.J., WangR., CollierA., McElrathM.J.Effect of adjunct hydroxyurea on helper T cell immunity in HIV type 1-infected patients with virological suppression. AIDS Res Hum Retroviruses.2004; 20(8): 807–12.
21.
StebbingJ., NelsonM., OrkinC.A randomized trial to investigate the recycling of stavudine and didanosine with and without hydroxyurea in salvage therapy (RESTART). J Antimicrob Chemother.2004; 53(3): 501–5.
22.
LoriF., MalykhA.G., FoliA.Combination of a drug targeting the cell with a drug targeting the virus controls human immunodeficiency virus type 1 resistance. AIDS Res Hum Retroviruses.1997; 13(16): 1403–9.
23.
PearceD.J., ThomasC.G., FleischerA.B.Jr., FeldmanS.R.The cost of psoriasis therapies: considerations for therapy selection. Dermatol Nurs.2004; 16(5): 421–8, 432.
