HIV dermatology

Question 1

HIV dermatology - seborrheic dermatitis

Answer 1

Very common in HIV
Worse at lower CD4 counts
Will improve with ART

Erythema/fine scale = scalp/eyebrows/alar crease/axilla/groin

Treatment:
-Clotrimazole 1% cream
-Hydrocortisone
-Other treatments = econazole cream, ketoconazole cream

Question 2

HIV dermatology - xerosis/eczema

Answer 2

Particularly bad at low CD4 counts
May not improve with ART
Gentle skin care - emollients 1st line

Treatment = topical steroids - betamethasone valerate, hydrocortisone

Question 3

HIV dermatology - papular pruritic eruption of HIV

Answer 3

Low CD4
High viral load
Symmetric excoriated papules on extremities
Exaggerated bug bite response
ART may be helpful
Treatment = topical steroids

Question 4

HIV dermatology - zoster

Answer 4

Common in HIV
Painful vesicular lesions
Dermatomal and/or group
Pain/itch precedes rash 2-3 days

Treatment:
-Antivirals = aciclovir [in acute setting]
-TCA/Gaba for post-herpetic neuralgia [PHN not more common in HIV]

Question 5

HIV dermatology - Kaposi’s sarcoma

Answer 5

Severe disease at low CD4
Consider if lungs/gut involved
Need ART
If disease severe - will need additional chemo
Treatment:
-ART
-Doxorubicin/adriamycin
-Bleomycin
-Vincristine
-Liposomal doxorubicin

Question 6

HIV dermatology - warts

Answer 6

Genital and common warts very common in HIV
Worse with low CD4 count - may not get better with ART
Increased risk of neoplastic transformation so need to monitor

Treatment:
-Salicylic acid
-Podophyllum
-Imiquimod - less effective in HIV

Question 7

HIV dermatology - psoriasis

Answer 7

Paradoxically worse disease at low CD4 counts
Will improve with ART
Well demarcated silvery scaly plaques - extensor surfaces, may affect nails and joints

Treatment = betamethasone, ART

Question 8

HIV dermatology - eosinophilic folliculitis

Answer 8

CD4 <200
Patients within 3-6 months of initiating ART
Truncal, itchy acneiform eruption

Treatment = itraconazole, permethrin, phototherapy
Wait for immune reconstitution to settle [3-6 months after starting ART]

Question 9

HIV dermatology - Herpes simplex

Answer 9

Transmission and acquisition x4 times more likely in people with HIV
Ulcerated lesions with scalloped borders - genital or perioral locations
Treatment = aciclovir

Aciclovir resistant = x10 more common in immunocompromised
Imiquimod can be used instead

Question 10

HIV dermatology - molluscum contagiosum

Answer 10

Low CD4 count
May be extensive - often facial involvement
Improve with ART