« Back to Cutaneous Manifestations of Internal Diseases

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?

 
 
 

Do any photosensitive dermatoses occur in HIV disease?

Various photosensitive dermatoses have been described in HIV disease, and these include porphyria cutanea tarda (PCT), lichenoid photoeruptions, and chronic actinic dermatitis. Photosensitivity may, in fact, be the presenting sign of HIV infection.

Most cases of PCT in HIV infection are acquired and many are associated with historical or serologic evidence of hepatitis B or C infection, as well as with elevated transaminase levels and history of alcohol abuse. Patients present with blisters, erosions, crusting, scarring, and increased skin fragility on the face and dorsal hands. In one study, urinary and stool porphyrin excretion patterns classic for PCT occurred in hepatitis C–positive AIDS patients without any clinical evidence of porphyria.

Lichenoid photoeruptions in HIV infection occur most often in black individuals with advanced HIV disease and may be associated with photosensitizing drug use. Patients present with pruritic, violaceous plaques that begin on the face, neck, dorsal hands, and arms. The plaques may become hyperpigmented, hypopigmented, or depigmented and may extend to non–sun-exposed sites. Histopathologic features are primarily those of lichenoid drug eruption or hypertrophic lichen planus, but some patients have findings of lichen nitidus. Patients may improve or clear with discontinuation of a photosensitizing drug, sun avoidance, and sunscreen use.

Chronic actinic dermatitis has been described in markedly immunosuppressed patients and presents as a chronic pruritic and idiopathic eczematous dermatitis in a photodistribution. Phototesting shows increased sensitivity to ultraviolet B. Histologic findings demonstrate eczematous, lymphoma-like, and psoriasiform changes.

O’Connor WJ, Murphy GM, Darby C, et al: Porphyrin abnormalities in acquired immunodeficiency syndrome, Arch Dermatol 132:1443–1447, 1996.