Human Papillomavirus Within Psoriasis Plaques in a Patient With Psoriasis: A Case Report

Abstract

Introduction: Psoriasis may be triggered by several factors, and its pathophysiology is related to inflammatory cellular processes. We herein describe a patient with psoriasis who developed warts on multiple psoriasis plaques and was successfully treated with systemic subcutaneous methotrexate. Case presentation: A 67-year-old man who had been diagnosed with psoriasis 14 years previously developed an outbreak of small erythematous desquamative plaques distributed symmetrically on his arms and trunk. Multiple spiny whitish papules had developed over his previously established psoriasis lesions. The appearance of the papules was consistent with viral warts. The patient was treated with systemic methotrexate injected subcutaneously and oral folic acid, both dosed weekly. This treatment produced good results. Discussion: A remarkable feature of this case is that psoriasis was the first diagnosis and that human papillomavirus (HPV) appeared over widespread erythematous squamous plaques. The pathophysiology of psoriasis is related to inflammatory cellular processes. Some authors have reported that HPV proteins may stimulate keratinocyte proliferation. Others have reported that HPV infection mostly stimulates systemic interleukin 17 production; consequently, HPV infection could provide a better environment for interleukin 17 secretion and facilitate new onset of psoriasis. One report indicated that methotrexate was discontinued in a patient who presented with both pathologies, although we had very good results. Conclusion: Psoriasis and HPV may be pathophysiologically related. HPV may stimulate keratinocyte proliferation and systemic interleukin 17 production, resulting in a better environment for psoriasis. Systemic methotrexate injected subcutaneously resulted in a good outcome in our patient.