Dermatological Conditions

Alexis Lara Rivero1, Mark Kelly2, Cassy Workman3, Margot Whitfeld1

  1. Skin and Cancer Foundation. Sydney NSW
  2. Armidale Rural and Referral Hospital, Armidale, NSW
  3. Enmore Medical Practice, Sydney, NSW

Approach to dermatological presentations

Dermatological conditions are common at all stages of human immunodeficiency virus (HIV) infection. Cutaneous manifestations of HIV can present as the initial sign of HIV infection either as part of a seroconversion illness or in association with infectious, inflammatory and neoplastic diseases, or even as a cutaneous drug reaction.   Since the advent of combination antiretroviral therapy (ART), dermatological presentations are increasingly encountered in the setting of immune reconstitution inflammatory syndrome (IRIS).

Although a few skin conditions occur almost exclusively in people with HIV infection, in general, the spectrum of dermatological conditions (Table 1) is similar to that found in the general population. These general dermatological problems may present as classically seen, or be found more frequently, or be atypical in presentation. Depending on the degree of immune suppression involved they are often less responsive to the usual therapies. Dermatological disease is a common presentation of IRIS and may associate with other organ involvement. With the restoration of the immune system the prognosis for resolution of skin disease is generally good.

Table 1          The spectrum of dermatological conditions affecting people with HIV infection

Rash morphology

Differential diagnosis

Follicular

Bacterial,  follicular eczema, eosinophilic folliculitis and Malassezia folliculitis

Eczematous

Psoriasis, dermatitis, Reiter syndrome, drug eruptions

Papular

Molluscum contagiosum, human papillomavirus, scabies cryptococcosis, and Kaposi sarcoma, pruritic and papular eruption of HIV

Macular / maculopapular

Secondary syphilis, parvovirus B19, disseminated candidiasis, widespread scabies and drug reactions
Consider opportunistic infections with skin manifestations, such as cryptococcosis, penicillinosis, histoplasmosis and coccidioidomycosis

Vesicular

Herpes zoster (varicella-zoster virus), herpes simplex virus and drug reactions

Petechial / pustular

Bacterial causes such as disseminated gonococcal infection, pseudomonal or staphylococcal sepsis, infective endocarditis, listeriosis. Also viral causes such as parvovirus B19, cutaneous vasculitis and drug reactions

Nodular

Prurigo nodules from persistent scratching, basal and squamous cell carcinomas, Kaposi sarcoma, mycobacteria,

Bartonella, histoplasmosis