Common skin manifestations of HIV/AIDS
Up to 92% of HIV/AIDS patient will have one or more skin disorders during the course their illness The cutaneous manifestations occurring in HIV infection are mostly due to the alterations in the immune system. Presenting with atypical presentation, more disseminated disease, or being resistant to conventional therapies and patient having related disorders eg candidiasis, H. zoster – etc and the general condition of the patient wasted etc
1- Seroconversion illness: - Acute primary HIV infection may lead to a transient, generalized, morbilliform eruption on the trunk and the arms. Some 25% will have exanthema
2- Skin conditions at early and intermediate stage of the disease With the onset of immunosuppression, skin changes are nonspecific such as common disorders with atypical clinical features, including recurrent varicella zoster, numerous hyperkeratotic warts, treatment-resistant seborrhoeic dermatitis, and oral hairy leukoplakia
a) Seborrhoeic dermatitis 85%
seborrheic dermatitis–like eruptions are observed in 85% of patients with AIDS. It may be the initial cutaneous manifestation of HIV disease. The eruption, which is characterized by widespread inflammatory and hyperkeratotic lesions in seborrhoeic areas, may progress to erythroderma in some patients.
Seborrheic dermatitis may be increased in patients with AIDS-associated dementia or CNS disease.
The immune alterations caused by HIV infection may lead to psoriasis and Reiter syndrome. In some instances, pre-existing psoriasis may become more severe with disseminated plaques and pustules.
b. Pityriasis rosea may accompany HIV disease with extensive erythematous plaques skin lesion with history of herald patches. They can have repeated episodes of pityriasis rosea.
c) Scabies can be found in all forms of HIV. Classical scabies occurs commonly with HIV.
Norwegian (crusted) Scabies Atypical scabies which is characterized by wide spread hyperkeratotic plaque occurs on palms and soles, scaly maculopapular eruption or crusted can occur in classical sites but can also be generalized involving face and all parts of the body
d) Xerosis (dryness of the skin) and acquired ichthyosis: 25-30%
Generalized dry skin syndrome is frequently observed in patients with HIV infection. Xerosis may be the initial clinical manifestation of AIDS, and it is often a cause of pruritus.
Acquired ichthymosis may begin on the lower extremities and disseminate in advanced HIV disease. Acquired ichthymosis may be a marker of concomitant infection with HIV-1 and human lymphotropic virus II in persons who uses intravenous drugs and who have profound helper T – cell depletion.
e) Herpes zoster- with lower CD4 counts CD4 counts (300-400cell/mm3) it tends to be mutidermatomal or hemorrhagic, disseminated or even ulcerated or recurrent and it also can occur outside limited dermatome.
f) Human papilloma virus (HPV) infection
In patients infected with HIV, widespread or recalcitrant warts may be observed on the oral mucosa, the face, the perianal region, and the female genital tract. The perianal and cervical lesions may be difficult to treat. Large plantar warts caused by HPV-66 and an epidermodysplasia verruciformis like eruption (numerous plane warts on sun exposed parts of the body), which is believed to be associated with HPV infection, have also been reported in patients infected with HIV.
g) Pruritic papular eruption (PPE)
PPE is a common cutaneous manifestation in patients infected with HIV. It manifests as small, itchy, red or skin-colored papules on the head, the neck, and the upper part of the trunk. The cause is not known. About 81.25% of patients with PPE have advanced immunosuppression.
3-Skin conditions with advanced disease - In the later stages of HIV disease, chronic HSV, MC, and CMV appears. Mycobacterial infections and mucocutaneous candidiasis occur.
a) Oral pharyngeal candidiasis
b) Oral hairy leukoplakia Epstein-Barr virus (EBV) has been implicated in the pathogenesis of oral hairy leukoplakia. Oral hairy leukoplakia, which is characterized by filiform white papules localized on the sides of the tongue, may develop in patients infected with HIV. Oral hairy leukoplakia has no malignant potential, but it may be the initial sign of progressive immunosuppression. White plaques may be confused with oral candidiasis, lichen planus, and geographic tongue.
c) Eosinophilic folliculitis manifests as an idiopathic, highly pruritic, papulopustular eruption of sterile pustules around hair follicles involving the face, the neck, the trunk, and the extremities.
d) Herpes ulcer – chronic herpes simplex ulcer More than 1 month
Chronic perianal and perioral herpetic ulcers caused by HSV and disseminated CMV infection. Recurrent oral and anogenital HSV is common in patients infected with HIV, and it may lead to chronic ulcerations. In pediatric patients, herpes simplex stomatitis is more common than varicella zoster virus (VZV), and it may become chronic and ulcerative.
e) Cytomegalovirus infection
f) Molluscum contagiosum (MC) in adults.
Usually occurs in children, but with HIV it can occur in adults. Molluscum contagiosum can become confluent and giant. MC nodules can occur with HIV.
g) Bacillary angiomatosis , which is caused by Bartonella henselae and rarely by
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