Spontaneous remission to complete unresponsiveness to all therapy has been described for HIV-related psoriasis, particularly following commencement of ART and normalisation of CD4+ counts. (119, 120) Topical therapy includes emollients, coal tar, salicylic acid, vitamin D analogs, and corticosteroids. Referral to a dermatologist is indicated in cases refractory to topical therapies, with significant body surface involvement or to impairment of quality of life. (121) Systemic therapies include acitretin, methotrexate and cyclosporine (122) Phototherapy has been shown to be safe and effective in PLWHIV. (123, 124)

Oral small molecule inhibitors including apremilast or deucravactinib have demonstrated high efficacy in psoriasis, however evidence for their safety in patients with HIV is limited to case reports. (125, 126) Biologics targeting specific inflammatory pathways have emerged as highly effective treatments for psoriasis with superior safety profiles compared to classical immunosuppressants. (127) In Australia, patients are eligible for biologics for psoriasis should they have severe disease and fail or have contraindications to multiple standard systemic treatments. (128) Of note, clinical trials for all these novel therapies in psoriasis excluded PLWHIV, however small real-world studies have not shown an adverse effect on viral load or CD4+ cell counts. (129)