Download HIV AND THE SKIN Seborrhoeic dermatitis

HIV AND THE SKIN
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Seborrhoeic dermatitis
Only 1-3% of the general population have
seborrhoeic dermatitis compared with 20-85% of
patients with HIV. Seborrhoeic dermatitis is
commoner in seropositive than in seronegative
homosexual men.
its severity is increased at CD4 T-cell counts
below 100 .Itchy, scaly patches are found at the
classical sites for seborrhoeic dermatitis.
Management follows conventional lines:
emollients, topical steroids and antifungals and
oral imidazoles.
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Drug reactions
Of patients with Pneumocystis jiroveci
pneumonia treated with co-trimoxazole, 60%
experience fever, nausea, vomiting and a rash.
Xerosis and cheilitis are common with PIs.
Lipodystrophy, retinoid-like effects particularly
indinavir-paronychia, periungual pyogenic
granuloma-like lesions, xerosis and cheilitis, and
curly hair
Zidovudine:trichomegaly, alopecia,nail
Pigmentation, Longitudinal melanonychia
Bacilary angiomatosis
 caused by the Gram-negative cat-scratch
disease organism Bartonella (previously
Rochalimaea) henselae affecting the skin.
 presents with purple, papular and nodular
vascular lesions resembling KS. Diagnosis
is achieved by skin biopsy.
 Bacillary angiomatosis responds to oral
erythromycin in most patients; isoniazid,
rifampicin, ethambutol or clofazimine,
either in addition to or instead of
erythromycin, have also been used.
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Candidosis. Oral candidosis has classically
been associated with immunosuppressive
states and was one of the first features to be
recognized in the early days of the HIV
epidemic before the syndrome was clearly
defined and the causative agent identified.
Oesophageal candidosis is an AIDS-defining
diagnosis.
Scabies has been endemic in the HIV
population and there are occasional epidemic
outbreaks on HIV wards, in hospices and in
the community. Transmission is by sexual
intercourse, nursing, comforting and
massage. Norwegian/crusted scabies is
highly contagious and its diagnosis should
arouse suspicion of underlying HIV infection.
Kaposi's sarcoma
 KS is caused by infection with human
herpes virus (HHV)-8 (KSHV). It is
probably transmitted sexually, more by
the faecooral route or the ejaculate than
by blood, in HIV-positive homosexual
men. HIV / AIDS-related KS may be a
disseminated disease with gastrointestinal
and pulmonary involvement. Cutaneous
KS is multicentric and often involves the
face, oral mucosa, palate and genitalia.
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Oropharynx
Distressing mouth ulceration occurs frequently. The
differential diagnosis includes malignancy (KS and
lymphoma), HSV,CMV, fungal infections, Behcet's disease,
drug-induced ulceration(e,g. didanosisne-ddI, DDI), and
idiopathic aphthous ulceration.
Oral candidosis is very common in HIV-positive individuals
and almost universal in AIDS.
Hairy leukoplakia is a new clinical entity that has emerged
during the HIV epidemic and is probably associated with
EpsteinBarr virus infection. It is usually asymptomatic,
although patients have often noticed the appearance of a
roughened patch along the lateral margin of the tongue. is
now known to occur in other immunocompromised people
and has even been reported in healthy individuals.