Alexis Lara Rivero1, Mark Kelly2, Cassy Workman3, Margot Whitfeld1
- Skin and Cancer Foundation. Sydney NSW
- Armidale Rural and Referral Hospital, Armidale, NSW
- Enmore Medical Practice, Sydney, NSW
Last reviewed: April 2016
Next review due: March 2020
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 |
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 |