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July 1993, Vol 129, No. 7 >
Article | July 1993

Cimetidine as Therapy for Treatment-Resistant Psoriasis in a Patient With Acquired Immunodeficiency Syndrome

Kenneth F. Wagner, DOCDR ; Henry G. Skelton, MCCOL ; Kathleen J. Smith, MCCDR ; Josef K. Yeager, MCLT ; Mitchell E. Stashower, MC
[+] Author Affiliations

USNR; USN, National Naval Medical Center, Bethesda, Md; USA; Walter Reed Army Institute of Research, Washington, DC; USN, Armed Forces Institute of Pathology, Washington, DC; Henry M. Jackson Foundation, Rockville, Md


Arch Dermatol. 1993;129(7):848-850. doi:10.1001/archderm.1993.01680280036005
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References
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REPORT OF CASE  In January 1989, a 28-year-old black man severely affected with the acquired immunodeficiency syndrome developed diffuse psoriasiform lesions characterized by welldemarcated, erythematous plaques with adherent silvery scale, predominantly involving the trunk (Fig 1) and the extensor surfaces of the extremities. Punch biopsy was performed, and the specimen was stained with Leder stain (chloroacetate esterase) that showed regular acanthosis with clubbed rete ridges, confluent parakeratosis, and a perivascular infiltrate of lymphocytes and mast cells (Figs 2 and 3). The patient had no family history of psoriasis.In September 1989, a regimen of oral zidovudine (500 mg/d) and aerosolized pentamidine (300 mg/mo) was started. Throughout the course of his disease, these medications did not affect his psoriatic lesions. In the 18 months following the development of psoriasis, multiple topical medications including tar, anthralin, and potent corticosteroids were tried but did not result in improvement of the lesions.

THERAPEUTIC CHALLENGE 

REFERENCES

1 +
Duvic M, Johnson T, Rapini R, et al.  Acquired immunodeficiency syndrome-associated psoriasis and Reiter's syndrome . Arch Dermatol. 1987;;123:1622-1632.
2 +
Fry L.  Psoriasis . Br J Dermatol. 1988;;199:445-461.
3 +
Bos J.  The pathomechanisms of psoriasis: the skin immune system and cyclosporine . Br J Dermatol. 1988;;118:141-155.
4 +
Duvic M.  Immunology of AIDS related to psoriasis . J Invest Dermatol. 1990;;95( (suppl) ):38s-40s.
5 +
Tschachler E, Groh V, Popovic M, et al.  Epidermal Langerhans cells: a target for HTLV III/LAV infection . J Invest Dermatol. 1987;;88:233-237.
6 +
Johnson T, Duvic M, Rapini R, et al.  AIDS exacerbates psoriasis . N Engl J Med. 1985;;313:1415.
7 +
Noonan F, Kripke M, Pedersen G, et al.  Suppression of contact hypersensitivity in mice by ultraviolet radiation is associated with defective antigen presentation . Immunology. 1981;;43:527-533.
8 +
Stingl G, Gazze-Stingl L, Aberer W, et al.  Antigen presentation by murine epidermal Langerhans' cells and its alteration by ultraviolet B light . J Immunol. 1981;;127:1707-1713.
9 +
Allen BR.  Use of cyclosporin for psoriasis in HIV-positive patient . Lancet . 1992;;339:686.
10 +
Fleury S, Lamarre D, Meloche S, et al.  Mutational analysis of the interaction between CD4 and class II MHC: class II antigens contact CD4 on a surface opposite the gp 120-binding site . Cell . 1991;;66:1037-1049.
11 +
Maddox J.  AIDS research turned upside down . Nature . 1991;; 353:297.
12 +
Ehmann C, Voorhes J.  International studies of the efficacy of etretinate in the treatment of psoriasis . J Am Acad Dermatol. 1982;; 6:692-696.
13 +
McCallum D, Grant P.  Cimetidine and psoriasis . Lancet . 1978;; 2:1314-1315.
14 +
Rai G, Webster S.  Cimetidine and psoriasis . Lancet . 1979;;1:50.
15 +
Long P, Miller O.  Cimetidine and psoriasis . Arch Dermatol. 1981;;117:523.
16 +
Wallach D, Cottenot F.  Cimetidine vs placebo in the treatment of psoriasis . Dermatologica. 1982;;165:197-203.
17 +
Merk H, Goerz G, Runne U, et al.  Cimetidine and chlorpheniramine in the treatment of psoriasis . Dermatologica. 1983;;166:94-96.
18 +
Nielsen HJ, Nielsen H, Georgensen J.  Ranitidine for improvement of treatment-resistant psoriasis . Arch Dermatol. 1991;;127:270.
19 +
Nielsen HJ.  Histamine and histamine type-2 receptor antagonists in psoriasis . Dan Med Bull. 1991;;38:478-480.
20 +
Nolte H, Skov P.  Inhibition of basophil histamine response by methotrexate . Agents Actions. 1988;;23:173-176.
21 +
Pedersen C, Permin H, Skov P, et al.  Inhibitory effect of cyclosporine A on histamine release from human leukocytes and rat mast cells . Allergy. 1985;;40:103-107.
22 +
Beer D, Matloff S, Rocklin R.  The influence of histamine on immune and inflammatory responses . Adv Immunol. 1984;;35:209.
23 +
Hellstrand K, Hermodsson S.  Cell to cell mediated interaction involving monocytes and non-T/CD 16+ NK cells is required for H2 receptor mediated NK-cell activation . Scand J Immunol. 1990;;31: 631-644.
24 +
Kumar A.  Cimetidine: an immunomodulator . DICP Ann Pharmacother. 1990;;24:289-295.

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1 +
Duvic M, Johnson T, Rapini R, et al.  Acquired immunodeficiency syndrome-associated psoriasis and Reiter's syndrome . Arch Dermatol. 1987;;123:1622-1632.
2 +
Fry L.  Psoriasis . Br J Dermatol. 1988;;199:445-461.
3 +
Bos J.  The pathomechanisms of psoriasis: the skin immune system and cyclosporine . Br J Dermatol. 1988;;118:141-155.
4 +
Duvic M.  Immunology of AIDS related to psoriasis . J Invest Dermatol. 1990;;95( (suppl) ):38s-40s.
5 +
Tschachler E, Groh V, Popovic M, et al.  Epidermal Langerhans cells: a target for HTLV III/LAV infection . J Invest Dermatol. 1987;;88:233-237.
6 +
Johnson T, Duvic M, Rapini R, et al.  AIDS exacerbates psoriasis . N Engl J Med. 1985;;313:1415.
7 +
Noonan F, Kripke M, Pedersen G, et al.  Suppression of contact hypersensitivity in mice by ultraviolet radiation is associated with defective antigen presentation . Immunology. 1981;;43:527-533.
8 +
Stingl G, Gazze-Stingl L, Aberer W, et al.  Antigen presentation by murine epidermal Langerhans' cells and its alteration by ultraviolet B light . J Immunol. 1981;;127:1707-1713.
9 +
Allen BR.  Use of cyclosporin for psoriasis in HIV-positive patient . Lancet . 1992;;339:686.
10 +
Fleury S, Lamarre D, Meloche S, et al.  Mutational analysis of the interaction between CD4 and class II MHC: class II antigens contact CD4 on a surface opposite the gp 120-binding site . Cell . 1991;;66:1037-1049.
11 +
Maddox J.  AIDS research turned upside down . Nature . 1991;; 353:297.
12 +
Ehmann C, Voorhes J.  International studies of the efficacy of etretinate in the treatment of psoriasis . J Am Acad Dermatol. 1982;; 6:692-696.
13 +
McCallum D, Grant P.  Cimetidine and psoriasis . Lancet . 1978;; 2:1314-1315.
14 +
Rai G, Webster S.  Cimetidine and psoriasis . Lancet . 1979;;1:50.
15 +
Long P, Miller O.  Cimetidine and psoriasis . Arch Dermatol. 1981;;117:523.
16 +
Wallach D, Cottenot F.  Cimetidine vs placebo in the treatment of psoriasis . Dermatologica. 1982;;165:197-203.
17 +
Merk H, Goerz G, Runne U, et al.  Cimetidine and chlorpheniramine in the treatment of psoriasis . Dermatologica. 1983;;166:94-96.
18 +
Nielsen HJ, Nielsen H, Georgensen J.  Ranitidine for improvement of treatment-resistant psoriasis . Arch Dermatol. 1991;;127:270.
19 +
Nielsen HJ.  Histamine and histamine type-2 receptor antagonists in psoriasis . Dan Med Bull. 1991;;38:478-480.
20 +
Nolte H, Skov P.  Inhibition of basophil histamine response by methotrexate . Agents Actions. 1988;;23:173-176.
21 +
Pedersen C, Permin H, Skov P, et al.  Inhibitory effect of cyclosporine A on histamine release from human leukocytes and rat mast cells . Allergy. 1985;;40:103-107.
22 +
Beer D, Matloff S, Rocklin R.  The influence of histamine on immune and inflammatory responses . Adv Immunol. 1984;;35:209.
23 +
Hellstrand K, Hermodsson S.  Cell to cell mediated interaction involving monocytes and non-T/CD 16+ NK cells is required for H2 receptor mediated NK-cell activation . Scand J Immunol. 1990;;31: 631-644.
24 +
Kumar A.  Cimetidine: an immunomodulator . DICP Ann Pharmacother. 1990;;24:289-295.

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