Psoriasis and Seborrheic Dermatitis

[leese43]

I have suffered with Seborrheic Dermatitis since sero-conversion and Psoriasis followed that winter. When I first spoke to my doctor about it she said that it had nothing to do with HIV, something I have never agreed with as my skin was always fine before.

Over the last couple of months I have been thinking about whether to start meds or not and I've decided that if I there was a chance that my skin would be better then I would probably start as it's really getting me down.

i was wondering if there is anyone out there that has been in a similar situation and found that meds helped with their skin? Not really asking about those that had skin problems when there cd4 was very low, but more those in the "normal" range.

Leese

[elf]

Those skin ''reactions'' have more to due with the abnormal high values of CD8 T than  with low CD4 T.
They can be controlled w/ shampoos (for hair) and antifungal cream for face. Topical corticosteroids are used with persistent conditions.

My seborrheic dermatitis had always been slight.
But HIV makes everything more severe, it's like a multiplying factor: my myopia got worse (from -0.25 to -0.5/0.75), my dandruff ''progressed'' to seborrheic dermatitis, my eye floaters got more annoying...

[Miss Philicia]

If your doctor said that seborrheic dermatitis has nothing to do with HIV then you might ask to see if she received her medical degree from a beautician school.  It's well documented and occurs in a high percentage of HIV patients -- totally the most common skin problem with HIV.

[leese43]

If your doctor said that seborrheic dermatitis has nothing to do with HIV then you might ask to see if she received her medical degree from a beautician school.  It's well documented and occurs in a high percentage of HIV patients -- totally the most common skin problem with HIV.

Yea that's what I'd read. She seemed to think that it couldn't be because my counts were good. I have a new doctor now, just didn't think to ask him about it last time i saw him. This is something I've been thinking about while weighing up the pros and cons of starting meds.

[leese43]

Those skin ''reactions'' have more to due with the abnormal high values of CD8 T than  with low CD4 T.
They can be controlled w/ shampoos (for hair) and antifungal cream for face. Topical corticosteroids are used with persistent conditions.

My seborrheic dermatitis had always been slight.
But HIV makes everything more severe, it's like a multiplying factor: my myopia got worse (from -0.25 to -0.5/0.75), my dandruff ''progressed'' to seborrheic dermatitis, my eye floaters got more annoying...

Thanks Elf, I use steroid creams along with shampoo etc but as you probably know can't use long term and as soon as I stop it flares up again.

[Miss Philicia]

Yea that's what I'd read. She seemed to think that it couldn't be because my counts were good. I have a new doctor now, just didn't think to ask him about it last time i saw him. This is something I've been thinking about while weighing up the pros and cons of starting meds.

Yeah, your numbers are on the high side for it but I know I had the evil SD at those similar numbers.  I didn't get good control of it until they were stable ~6-700 for a year.  Now, I don't know how bad you have it but I can dig around for the tubes of prescription ointments that I used.  You have to use them every day for a good month depending on severity.  I also found that after you get it under control it helps to use a facial cleanser containing glycolic acid, and I still use this even today though my numbers are way high.  I specifically use Derma-E's Glycolic Facial Cleanser with marine plant extracts, but I see you are not US based so I don't know if that would be easy for you to find.

I'd advise locating a proper dermatologist who has experience treating patients with HIV if you do not feel that your general practitioner and/or HIV specialist is paying proper attention to this issue.  A red face is not good for the soul.

[leese43]

Yeah, your numbers are on the high side for it but I know I had the evil SD at those similar numbers.  I didn't get good control of it until they were stable ~6-700 for a year.  Now, I don't know how bad you have it but I can dig around for the tubes of prescription ointments that I used.  You have to use them every day for a good month depending on severity.  I also found that after you get it under control it helps to use a facial cleanser containing glycolic acid, and I still use this even today though my numbers are way high.  I specifically use Derma-E's Glycolic Facial Cleanser with marine plant extracts, but I see you are not US based so I don't know if that would be easy for you to find.

I'd advise locating a proper dermatologist who has experience treating patients with HIV if you do not feel that your general practitioner and/or HIV specialist is paying proper attention to this issue.  A red face is not good for the soul.

I have it pretty bad right now so am grateful for any advice on what to use. The prescribed cream I use at the moment is called Dacktacort. it works ok but as soon as I stop it's back again. I've just googled Derma-E and we can get it here so it will be going on my shopping list..thanks

[Miss Philicia]

First, I'd still recommend going to a dermatologist as it sounds like what you have is worse than what I had.  But I've located my old creams, and there were two prescriptions: one was an alclometasone dipropionate ointment (0.05%) and the second was one with metronidazole gel (1%).  The first was made by Fougera and the second by Metrogel, but just go with my first descriptions as I'd figure in the UK these things have different brand names.  I used them for at least a month at night while sleeping.  They have a kind of slightly oily base so I'd either buy a set of cheap pillow covers that you don't care about and will later toss out and maybe and/or cover them with bath towels. 

If you purchase the Derma-E do not use it until you achieve a decent decline with the prescription meds.  If you have SD bad and just try to use Derma-E it won't work.  It's more of a maintenance thing.

But like I said, go to a dermatologist as if you have it worse than I did (and there's no way for me to tell without seeing you) then maybe you'll be prescribed something stronger.

[leese43]

Great, thanks. I'll go to the docs and ask for a referral..I'll take a note these too, see what they say.

[PozBrian]

I absolutely think that psoriasis can get worse with HIV. I have had psoriasis for 15 years and had pretty good control until just before I tested HIV+ when it flared up and became intensely itchy, flaky and would bleed if I scratched it too much. This coincided with a period where I felt fatigued and unmotivated. This is Feb 09 and in April I tested pos. It is why I think I was in the midst of my initial infection then.

Standard psoriasis meds (lidex and dovonex for me) did the trick as well as getting my hiv infection under control. The best understanding now is that psoriasis is an auto-immune disease. I'm not sure the exact mechanism of the relationships between hiv, CD4, cd8 and psoriasis. Seem that CD8 play a bigger role in psoriasis.

A simple google search for HIV and psoriasis will get you a lot of info. Here a couple though they are a bit technical.

http://dermatology.cdlib.org/132/reviews/HIV/fife.html

http://www.liebertonline.com/doi/abs/10.1089/108729100317696?journalCode=apc

Brian

[Inchlingblue]

I had Seborrheic Dermatitis about 8 months before I found out about the HIV so I likely was already poz.

It went away very quickly with a cream that was prescribed (can't remember the name).

As elf states, this condition is not likely due to low CD4 levels but rather elevated CD8 levels, which happens when a person has HIV. Elevated CD8s are a sign of sustained immune activation (soon after initial infection it's known as a "cytokine storm") which causes systemic inflammation and can lead to these skin conditions, which are not OIs per se.

[ademas]

I developed psoriasis as my numbers began improving.

Dovonex and steroid creams did nothing, and it began affecting my nials and joints (psoriatic arthritis).

I've been on Humira injections for several years now, and it's totally cleared up.  They're very expensive (25k per year for bi-monthly injections), but fortunately Medicare and my supplemental insurance pay in full.

I would suggest you see a rheumatologist who has experience treating autoimmune disorders with HIV+ patients.  I got absolutely no help from dermatologists.

[northernguy]

I have suffered with Seborrheic Dermatitis since sero-conversion and Psoriasis followed that winter. When I first spoke to my doctor about it she said that it had nothing to do with HIV, something I have never agreed with as my skin was always fine before.

Over the last couple of months I have been thinking about whether to start meds or not and I've decided that if I there was a chance that my skin would be better then I would probably start as it's really getting me down.

i was wondering if there is anyone out there that has been in a similar situation and found that meds helped with their skin? Not really asking about those that had skin problems when there cd4 was very low, but more those in the "normal" range.

Leese

I'm pretty much in the same boat as you.  My numbers were good but skin issues appeared right after seroconversion.  Search dermatitis or skin issues here and you'll find lots of posts.

Elidel helped with some of the worst flaky patches, but it suppresses the immune system, which seems an odd way to treat an HIV-related problem. My skin has been at its worst this winter.  My scalp is a flak mess and my whole face down to my neck is dry and sometimes flaky looking.  Like you., I'm thinking meds are going to be the best shot at dealing with this.

[leese43]

Thank you allfor the replies and links.

I've just recently been told about the injections by a friend who doesn't know the i'm poz. I didn't think that we were able to use it though, I will definately ask about it as hers has completely cleared up within 4 weeks of being on the injections. I'm in the UK so as long as the doctor felt it was the right medication then I wouldn't have to pay but that could also mean because it's expensive they may not want to use it. I've been offered light treatment but by the time the appointment came around last year spring had arrived and it wasn't so bad..also with this treatment I'd need to take a lot of time out from work..3 x a week for 10 weeks. That in itself is difficult to do.

I haven't had much luck with Dermatologists, I've only managed to see the consultant once and then you tend to be passed on to the registrars here.. a different one each time and to be honest I haven't had a lot of faith in them and they leave me feeling more miserable than when I went in. I am very thankful for the NHS but the downside is that you can't shop around for doctors as much as you can in the US.

[leese43]

Thought I'd giive an update on this.

Finally saw a dermatologist this morning and for the first time in 3 years feel that I have found a doctor that can actually look me in the eye when talking to me...probably because I requested a referral to the Chelsea and Westminster hospital in London and not the local one I usually go to, I'm sure they have more contact with HIVers there.

Anyway, I've been prescribed a tablet for the Seborrheic Dermatitis -Itraconazole plus Lotriderm cream and xamiol scalp gel. She's booking me light treatment for the Psoriasis.

I asked about the injection, she's not treated anyone with it who is also poz but said she'd do some research and let me know when i go back.

Fingers crossed this is going to work for me.

[northernguy]

I hope this works for you, please let me know. 

Sadly starting Atripla 7 weeks ago has done nothing for my skin.  Its worse than ever.

[Hellraiser]

I hope this works for you, please let me know. 

Sadly starting Atripla 7 weeks ago has done nothing for my skin.  Its worse than ever.

My initial reaction skin wise to the medication was very very bad and it's taken a good long time to get to a point where I feel comfortable going in public again.  However, my numbers were truly truly terrible and I'm not sure what yours were like.  I really don't think it's the medication that did it to me, but rather my body's reaction to the stuff that was hanging out on my skin and just being allowed to do it's own thing.