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Cutaneous Manifestations of Aids

»	How significant is the occurrence of skin disease in the setting of HIV infection?
»	Outline the clinical spectrum of cutaneous disease associated with HIV infection.
»	What are the most common dermatoses associated with HIV infection?
»	Can mucocutaneous changes occur as a result of primary HIV infection?
»	What is the most common bacterial pathogen in HIV disease? How does it manifest itself?
»	What is the most common cutaneous malignancy in HIV disease?
»	What are the cutaneous clinical features of epidemic Kaposi’s sarcoma?
»	How is Kaposi’s sarcoma treated?
»	Is the course of syphilis altered in HIV-infected individuals?
»	How does syphilis increase the risk for HIV infection?
»	What is oral hairy leukoplakia?
»	Name the four types of oropharyngeal candidiasis that can be seen in HIV disease.
»	What is HIV-associated eosinophilic folliculitis?
»	Is the incidence of drug eruptions increased in HIV disease?
»	Describe clinical features of molluscum contagiosum infection in the HIV-infected host.
»	How is molluscum contagiosum treated?
»	Is the prevalence of common and genital warts increased in HIV infection?
»	What causes bacillary angiomatosis?
»	How does varicella-zoster virus infection present in the HIV-positive patient?
»	Do any photosensitive dermatoses occur in HIV disease?
»	What is known about granuloma annulare in the setting of HIV infection?
»	Describe some of the potential cutaneous side effects of antiretroviral therapy.
»	What is the immune restoration syndrome?

Describe clinical features of molluscum contagiosum infection in the HIV-infected host.

Molluscum contagiosum, a poxvirus infection, is seen in approximately 8% to 18% of patients with symptomatic HIV disease and AIDS. Although molluscum lesions often appear as dome-shaped, flesh-colored umbilicated papules, they can have an unusual appearance, involve atypical sites, and be widespread.

In HIV disease, molluscum lesions tend to occur on the face, trunk, intertriginous areas, and buttocks as well as in the genital area. Beard area lesions are commonly seen, and these are probably spread by shaving. Lesions can be large (>1 cm, giant molluscum) or hyperkeratotic; can simulate skin cancers, common and genital warts, and keratoacanthomas; and can become confluent. Lesions can also involve the follicular epithelium with sparing of the interfollicular epithelium. Molluscum lesions can be associated with a localized chronic dermatitis surrounding a centrally located lesion (molluscum dermatitis). With progressive immune dysfunction, lesions increase in number and become diffuse. Disseminated cryptococcosis, histoplasmosis, and Penicillium marneffei infection can mimic facial molluscum contagiosum.

Mastrolorenzo A, Urbano FG, Salimbeni L, et al: Atypical molluscum contagiosum infection in an HIV-infected patient, Int J Dermatol 37:378–380, 1998.