Letters to the Editor /J. Ettr Acad. Dermatol. Venereol. 3 (1994) 555-56!

The results of this study have shown compara-tively better clinical results as compared to otheranalogues [1-4]. Our findings indicate that boththe interferons alpha-2b and IFN-beta wereequally effective in treating recurrent genitalwarts.

[1] Geffen JR, Klein JR. Friedman-Kien AE. Intralesionaladministration of large doses of human leukocyte inter-feron for the treatment of condylomata acuminata. JInfect Dis 1984;150:6l2-ftl5.

[2] Reichman RC, Bonncz W. Greisbarger C et al. Treat-ment of condylomata acuminatum with intralesionallyadministered interferons: A multiple placebo-controlledtrial. Clin Res 1986;34:535A.

[3] Reichman RC. David O et al. Treatment of condylomataacuminattim with three different interferons adminis-tered intralesionally. A double-blind, placebo-controlledtrial. Ann Int Med 19SS;i()8:675-679.

[4] Peterscn CS, Bjerring P. Larsen J. Blaakaer J. HagdrupH, From E. Obergaard L. Systemic interfercm alpha-2bincreiises the cure rate in laser treated patients withmultiple persistent genital warts: a placebo-controlledstudy. Genitourin Med 1991;67:99-102.

Tanweer A. Syed •̂*, Stefan Lundin ''. RiffatCheema ,̂ Munir Ahmad ^

•* Dept. of Clinical Physiology, University HospitalMalmo, University of Lund, S-2I401 Malmo, Swe-den. Dept. of Clinical Pharmacology, Lunds Uni-versity Hospital, University of Lund, Lund, Swe-den. "̂ Government Services Hospital, University ofthe Punjab, Lahore, Pakistan.9765, Doha, Qatar

Munir Clinic, POB

Corresponding author. Tel:-1-46-40-331442, Fax: -1-46-40-336254. 336620.

55£)/0926-9959(94)00050-A

Pruritic papular eruption in a patient with hu-man immunodeficiency virus infection

We report a case of a 52 year old HIV positivepatient referred to our department with an in-tractable pruritic papular eruption (PPE) of onemonth duration. Physical examination revealedoral candidiasis and non-confluent papules 2-3mm in diameter on the extensor surfaces of theupper and lower limbs. He had no other oppor-

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Fig. 1. Perivascular infiltrate with lymphocytes and increased number of eosiiiopluls.

Letters to the Editor/J. Ettr. Acad. Dermatol. Venereol. 3 (1994) 555-561 56t

tunistic infections, and was on prophylactic treat-ment with Zidovudinc, Fluconazolc and Pentami-dine aerosol. The patient had been previouslytreated, without any improvement, with 1% lin-dane, emollients, topical and oral steroids, oralantihistamincs as well as topical and oral antibi-otics.

Investigations showed 12% eosinophilia(leucocytes: 5200/mm'); total igE 440 U/ml(normal range: 10-70 U/ml) ; CD4 cells 120/mm\ The remainder of the laboratory data wasnormal. Microbiological investigations, includingscabies scrapings and special stains (Giemsa, PASand Gomori). were negative.

Two skin biopsy specimens showed discontinu-ous parakeratosis and dermal perivascular Iym-phocytic inflammatory infiltrate with increasednumber of eosinophils; there was no follicularinvolvement (see Fig. 1).

He was commenced on UVB phototherapy atan initial dose of 20 mj/cm". 3 times weekly,with 20 mJ/cm-^/day increments, not exceedinga maximum of 240 mJ/cm' . After one month oftreatment the lesions cleared and itching de-creased. A slight generalised itching persisted fortwo months. The patient then abandoned treat-ment. Three months later, the lesions recurredand pruritus increased. PUVA therapy wasstarted with the following regimen: 3 weekly ex-posures starting with an initial dose of 2 J/cm",with progressive 1 J/cm^ increments to a maxi-mum of 12 J / c m ' ; 2 hours before each exposurehe received oral 8-methoxipsoralcn (8-MOP), 0.6mg/kg. After 15 sessions treatment was aban-doned in view of the lack of response,.

Clinically similar although histologieally differ-ent papular eruptions have been described inHIV-infected patients [1], generally in associationwith itching.

UVB phototherapy has been successfully usedin treating HIV-positive patients with idiopathicgeneralised pruritus, eosinophilic pustular folli-culitis, and PPE in AIDS [1,2]. PUVA therapyand even UVA light alone have also been suc-cessfully used to treat pruritus in AIDS patients[1]. The mechanism by which UVB light andPUVA relieves the pruritus of PPE is unknown.

UV radiation has been reported to produce

negative effects on HIV-infected patients, includ-ing HIV activation 13]. UVB light induces impair-ment of immune response, demonstrated by stud-ies with human epidermal cells [4]. Pardo ct alfound no significant alterations in patient sys-temic immune status after treatment with UBVphototherapy [2]. PUVA therapy is transientlyimmunosuppressive and decreases the numberand antigen-presenting capacity of Langerhanscells [5]. Ranki et al. consider that systemic PUVAcan be safely used for the treatment of HIV-Ag-ncgative HIV-infected patients [5]. We considerthat until definitive information becomes avail-able, phototherapy should be considered as a lastoption in HIV-infected patients with PPE. In thereported case better results were obtained withUVB than with PUVA therapy, although fullremission was not achieved.

[1] Hulsebosch HJ. AIDS and itch. J Eur Acad DermaiolVenereol 1992;I:3I I-3I8.

[2] Pardo RJ, Bogaerl MA. Penneys NS el al. UVB pho-totherapy of the prurilic papular eruption of the acquiredimmunodeficiency syndrome. J Am Acad Dermatol1992:2(S:423-S.

[3] Walace BM. Lasker JS. Awakenings UV light andHIV gene activation. Science I992;257:1211-2.

[4] Auslad J. Braathen LR. Effect of UVB light on allo-activaiing and antigen presenting capacity of human epi-dermal Langerhans cells. Scand J Immunol I9H5;21:4I7-423.

[5] Mork N J, Gaudernack G, Braathen L. Effect of UVAand PUVA on alloactivating and antigen presenting ca-pacity of human epidermal Langerhans cells. Photoder-matology 1987:4:66-72.

[6] Ranki A. Puska P, Maltinen S et al. Effect of PUVA onimmunologic and virologic findings in HlV-infeeted pa-tients. J Am Acad Dermatol 1991:24:404-10.

Jorge A. Martinez *, Juan J. Vilata, Esther Que-cedo, Gabriel Serrano

Department of Dermatology, University GeneralHospital, Avda. Tres Cruces s/n, 46014-Valencia,Spain

* Corresponding author. Tel: +34-6-3862900 ext. 5719,Fax:+ 34-6-3503964.

550/0926-9959(94)00049-6