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MBBS 4: Dermatology > HIV and Dermatology > Flashcards

HIV and Dermatology Flashcards

1
Q

HIV induced immunodeficiency results in?

A
  1. severe clinical expressions of common
    skin infections
  2. unusual skin infections
  3. higher frequency of some known skin diseases, sometimes atypical presentation
  4. high frequency of itchy skin diseases
  5. Kaposi’s sarcoma
  6. B- and T-cell lymphoma
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2
Q

Epidemiology of HIV related skin diseases?

A
  1. Seborrhoic eczema: 85% (1-3% healthy population)
  2. Psoriasis: 1-5% (1-2% healthy pop)
  3. Oral Hairy Leucoplakia: EBV infection 25%
  4. Herpes zoster: 20-30% recurrent
  5. Herpes simplex: > 1 month, criterium for AIDS
  6. Candidiasis: 30-80%
  7. Pruritus: xerosis, pruritic papular eruption eosinophilic folliculitis
  8. Kaposi’s sarcoma: <10%
  9. Other skin diseases: eg infections, squamous cell
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3
Q

Primary HIV infection?

A
  • Mononucleosis-like illness, +/-septic meningitis, associated with seroconversion to HIV antibody
  • Incubation period: 10 dys – 5wks
  • Duration days to 2-3 weeks
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4
Q

Ddx for seroconversion rash?

A
  1. secondary syphilis
  2. infectious mononucleosis
  3. other viral exanthema
  4. pityriasis rosea
  5. psoriasis guttate
  6. drug eruptions
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5
Q

Dermatological markers of HIV/AIDS induced immunodeficiency?

A
  1. neoplasms
  2. non-infectious skin diseases
  3. skin infections
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6
Q

Dermatological markers of HIV/AIDS?

A
  1. immune restoration / reconstitution: effect on skin diseases and side-effects
  2. drug eruptions
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7
Q

HIV neoplasms?

A
  1. Kaposi sarcoma > 1000 x (HHV-8)
  2. Non-Hodgkin lymphoma 70 x (EBV)
  3. Cervical carcinoma 5x (HPV)
  4. Anal, penile, vulvar, vaginal carcinoma
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8
Q

Treatment of KS?

A
  1. ART (response rate 20 to 80%)
  2. Small lesions:
    Cryotherapy, surgery, electrocauterization, laser
  3. Localised disease:
    Intralesional vincristine, vinblastine, bleomycin, radiotherapy
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9
Q

Treatment of widespread KS?

A
  1. Chemotherapy (immediate / delayed):
  2. 1st line: Paclitaxel IV every 2 weeks x 6
  3. 2nd line: Bleomycine + vincristine
  4. 3rd line: Doxorubicin or other: Etoposide, Interferon alpha, Bevacizumab (VEGF inh),
    Imatinib, Thalidomide/ Pomalidomide (angiogenesis inhibition), Vinorelbine
    - Radiotherapy: RT regimens include single dose radiation (8 to 10 Gray) delivered to an extensive field to total body electron beam therapy (4 Gray) once a week for 6 to 8 weeks
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10
Q

Non-infectious skin disease in HIV?

A
  1. Seborrhoeic dermatitis
  2. Psoriasis
  3. Asteatosis cutis (dry skin) + eczema
  4. Pellagra
  5. Drug eruptions
  6. Papular pruritic eruption
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11
Q

DDX of erythema, scaling and pustules on the scalp?

A

Tinea capitis
Impetigo
Psoriasis
Scabies
Seborrhoic eczema
Crusted scabies

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12
Q

Describe seborrheic eczema?

A

Classically greasy scales in seborrhoeic areas (midline)
Associated with pityrosporon ovale, stress

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13
Q

Treatment rational for seborrheic eczema?

A
  1. anti-inflammatory
  2. anti-fungal
  3. anti-seborrhoeic
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14
Q

Treatment of seborrheic eczema?

A

Imidazole + hydrocortisone cream
Sometimes stronger steroids
Salicylic acid 2-5% ointment
Sulphur 3-5% ointment
Coal tar 2-6% in zincpaste, ointment
Systemic azoles in severe cases
Antiseptics / antibiotics as required

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15
Q

Describe psoriasis and HIV?

A
  • More common and more severe!
  • May be superinfected
  • Potent topical steroids and keratolytics eg salicylic acid 5 to 10% ointment
  • Usually responds to methotrexate
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16
Q

Ddx of psoriasis vulgaris?

A
  1. seborrheic dermatitis
  2. psoriasis
  3. asteatosis cutis
  4. pellagra
  5. drug eruptions
  6. papular pruritic eruption
17
Q

What is asteatosis cutis?

A

dry skin + asteatotic eczema
- dry, cracked and scaling skin

18
Q

Treatment for asteatosis cutis?

A

Moisturisers
e.g.
1. Emulsifying ointment
2. Urea 10% ointment
3. Vaseline

19
Q

What is pellagra?

A

Nicotinic acid (niacin, vit B3) deficiency
1. dermatitis
2. diarrhoea
3. dementia

20
Q

Adverse drug reactions in HIV?

A

TEN (toxic epidermal necrolysis) – co-trimoxazole
Steven Johnson Syndrome - mevirapine, antimalarials

21
Q

Describe papular pruritic eruption?

A
  • Very itchy papular and papulopustular skin eruptions
  • Probably hypersensitivity reactions
    to arthropods
22
Q

Treatment for papular pruritic eruption?

A
  1. Calamine lotion
  2. Antihistamines
  3. Topical corticosteroids
23
Q

Types of papular pruritic eruptions?

A

non-follicular - PPE
follicular – folliculitis

24
Q

Causes of itcht follicular eruptions?

A
  1. Staph.aureus folliculitis
    - Antibiotics
  2. Pityrosporon folliculitis
    - Antifungals
  3. Eosinophilic pustular folliculitis (Ofuji)
  4. Topicalsteroids
    - Zinc / calaminelotion
    - Dapsone
    - Systemicsteroids
    - Erythromycin
25
Viral infections?
* Herpes simplex virus (HSV 1,2) * Varicella Zoster virus (VZV) * Human papilloma virus (HPV) * Molluscum contagiosum virus * EBV (HHV 4) - oral hairy leukoplakia
26
Treatment of varicella?
Aciclovir + Calamine lotion Valaciclovir + Calamine / sulphur lotion Famciclovir
27
Hepres zoster?
Multidermatomal Disseminated Bacterial superinfection Scarring Delayed healing Complications
28
Treatment of herpes zoster?
Val)aciclovir, famciclovir NSAIDs Antibiotics
29
Human papilloma virus?
Common warts *Plane warts *Venereal warts = condylomata acuminata *Vulvar, cervical, vaginal, penile, anal intraepithelial neoplasia (VIN, CIN, VaIN, PIN, AIN)
30
Molluscum contagiosa?
circumscribed, white, domeshaped shiny papules with or without a dimple 1. in the immunecompetent: - infants - self-limiting 6 – 9 months 2. in the immunesuppressed: - multiple, confluent, persistent, giant
31
Treatment for molluscum contagiosum?
Trichloracetic acid Curettage Cryotherapy Cauterisation Tretinoin lotion Benzoylperoxide gel Phenol 80%
32
Bacterial infections?
Pyoderma * Mycobacterial infections * M. tuberculosis * NTM (non-tuberculous mycobacteria; M.avium intracellulare) * Bacillary angiomatosis (Bartonella) * Noma * Syphilis
33
Treatment of cryptococcal?
1. Amphotericin B + Flucytosine 2. Fluconazole + Flucytosine / Ampho B
34
Fungal infections?
Candidiasis * Pityrosporum infections * Dermatomycosis (Tinea) * Cryptococcosis * Histoplasmosis * Sporotrichosis
35
Treatment of scabies?
Treat all close contacts (household members) * Permetrin 5% cream * Benzoyl benzoate 35% children, pregnant women * Sulphur 5% ointment infants, pregnant women * Ivermectin * Post-scabies itch!
36
Skin side effects to HIV ART?
1. Lamivudine - Paronychia - Alopecia - Exanthema - Pruritus 2. Nevirapine, cotrim - Steven’s Johnson syndrome 3. Tenofovir, nevirapine, efavirenz, dolutegravir, etc - Maculopapular exanthema
37
Ocular complications?
◼ Dry eye syndrome - 59% ◼ Subconjunctival fibrous scarring – 33% ◼ Corneal punctate epithelial erosions – 29% ◼ Trichiasis – 29% ◼ Symblepharon – 14% ◼ Visual loss – 8%
38
Treatment of eye involvement?
* Opthalmologist during the acute phase of disease * Two hourly eye care * Preservative free lubricant eye drops * Surgical intervention? * Follow-up for at least 1 year
39
What is IRIS?
Immune Reconstitution Inflammatory Syndrome (IRIS) 5-50% of cases

MBBS 4: Dermatology (22 decks)

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