HIV in dermatology

Question 1

What type of skin neoplasm is most commonly associated with HIV/AIDS?

Answer 1

Kaposi’s sarcoma (associated with HHV-8) is strongly associated with HIV/AIDS, with a significantly increased incidence (over 1000 times more likely in HIV-positive individuals).

Question 2

What is the significance of oral hairy leukoplakia in an HIV-positive patient?

Answer 2

Oral hairy leukoplakia, caused by Epstein-Barr virus (EBV), is often seen in HIV-positive patients and indicates a weakened immune system.

Question 3

What are the differential diagnoses for HIV seroconversion rash?

Answer 3

Secondary syphilis
Infectious mononucleosis
Other viral exanthema
Pityriasis rosea
Psoriasis guttata
Drug eruptions

Question 4

What lymphatic neoplasm is associated with HIV/AIDS and what virus is it linked to?

Answer 4

Non-Hodgkin Lymphoma:

Incidence increased 70 times in HIV-positive patients.
Often associated with Epstein-Barr virus (EBV).

Question 5

Which carcinoma is more common in HIV/AIDS patients, and what is it associated with?

Answer 5

Cervical Carcinoma:

Incidence increased by 5 times in HIV-positive patients.
Associated with human papillomavirus (HPV).

Question 6

What is seborrhoeic eczema, and how does it present in HIV/AIDS patients?

Answer 6

Seborrhoeic Eczema:

Affects 85% of HIV-positive patients, compared to 1-3% of the healthy population.
Characterized by greasy scales in seborrhoeic areas (such as the midline of the face and scalp).
The condition may be more severe in HIV-positive individ

Question 7

What are the common locations for seborrhoeic eczema in HIV/AIDS patients?

Answer 7

Seborrhoeic eczema commonly affects seborrhoeic areas, including:

Scalp
Face (especially around the nose and eyebrows)
Chest

Question 8

How is seborrhoeic eczema treated in HIV/AIDS patients?

Answer 8

reatment for seborrhoeic eczema in HIV/AIDS patients includes:

Topical Treatments: Imidazole and hydrocortisone cream, stronger steroids if needed.
Other Options: Salicylic acid 2-5% ointment, sulfur 3-5% ointment, coal tar 2-6% in zinc paste.
Severe Cases: Systemic azoles may be used.
Treatment Rationale: Anti-inflammatory, antifungal, and anti-seborrhoeic effects.

Question 9

What factors are associated with the severity of seborrhoeic eczema in HIV/AIDS patients?

Answer 9

The severity of seborrhoeic eczema in HIV/AIDS patients is associated with:

The level of immune suppression
Stress
Associated with the fungus Pityrosporum ovale (Malassezia

Question 10

How does psoriasis vulgaris present in HIV/AIDS patients?

Answer 10

In HIV/AIDS patients, psoriasis vulgaris may present with:

Larger, more widespread plaques.
Increased severity.
Superinfection of lesions.

Question 11

What treatments are commonly used for psoriasis vulgaris in HIV/AIDS patients?

Answer 11

Treatment for psoriasis vulgaris in HIV/AIDS patients includes:

Topical Treatments: Potent topical steroids and keratolytics such as salicylic acid 5-10% ointment.
Systemic Therapy: Methotrexate is usually effective for more severe cases.

Question 12

What are the common symptoms of asteatosis cutis in HIV/AIDS patients?

Answer 12

Symptoms of asteatosis cutis include:

Dry, rough, and scaly skin.
Fine cracking, which may lead to eczema (asteatotic eczema).
Itchiness and discomfort.

Question 13

How is asteatosis cutis treated in HIV/AIDS patients?

Answer 13

reatment for asteatosis cutis includes:

Moisturizers: Emulsifying ointment, urea 10% ointment, or vaseline to hydrate and protect the skin.
Avoiding Irritants: Using gentle skin care products to prevent further drying and irritation.

Question 14

What is pellagra, and what causes it?

Answer 14

A condition caused by a deficiency of nicotinic acid (niacin, Vitamin B3).
It is often associated with malnutrition, which can occur in HIV/AIDS patients.

Question 15

What are the classic symptoms of pellagra?

Answer 15

The classic symptoms of pellagra are known as the “three Ds”:

Dermatitis: Characterized by a symmetric rash, especially in areas exposed to sunlight.
Diarrhea: Persistent gastrointestinal issues.
Dementia: Mental confusion, memory loss, and other neurological symptoms.

Question 16

How is pellagra treated in HIV/AIDS patients?

Answer 16

Treatment for pellagra includes:

Niacin Supplementation: Oral or intravenous administration of nicotinic acid (niacin).
Nutritional Support: Ensuring a well-balanced diet with adequate protein and vitamins.
Managing Underlying Conditions: Addressing any factors contributing to malnutrition or malabsorption in HIV/AIDS patients.

Question 18

Which antiretroviral drug is most commonly associated with Stevens-Johnson Syndrome (SJS) in HIV/AIDS patients?

Answer 18

Nevirapine

Question 19

What is papular pruritic eruption (PPE) in HIV/AIDS patients?

Answer 19

Papular Pruritic Eruption (PPE):

A condition characterized by intensely itchy papular (raised bumps) and papulopustular (bumps with pus) skin eruptions.
Commonly seen in HIV/AIDS patients.

Question 20

What are the possible causes of papular pruritic eruption in HIV/AIDS patients?

Answer 20

The exact cause of PPE is unclear, but it is believed to be:

A hypersensitivity reaction to arthropod bites (e.g., mosquitoes, bedbugs).
May also be linked to immune dysregulation in HIV/AIDS patients.

Question 21

What are the common causes of itchy follicular eruptions in HIV/AIDS patients?

Answer 21

Common causes of itchy follicular eruptions in HIV/AIDS patients include:

Staphylococcus aureus Folliculitis: Bacterial infection of hair follicles.
Pityrosporum Folliculitis: Fungal infection caused by Malassezia species.
Eosinophilic Folliculitis: Likely an immune reaction, seen particularly in advanced HIV disease

Question 22

How is Pityrosporum folliculitis managed in HIV/AIDS patients?

Answer 22

Management includes:

Antifungal Treatment: Topical antifungals like ketoconazole or oral antifungals such as itraconazole.
Hygiene Measures: Regular cleansing of the skin to reduce fungal load

Question 23

What is eosinophilic folliculitis, and how is it treated in HIV/AIDS patients?

Answer 23

Eosinophilic Folliculitis:

A condition characterized by intensely itchy, red, and pustular follicular eruptions.
Treatment: Topical corticosteroids, zinc/calamine lotion, dapsone, or systemic steroids in severe cases.

Question 24

What are the common types of warts caused by HPV in HIV/AIDS patients?

Answer 24

Common Warts (Verruca Vulgaris): Typically found on hands and feet.
Plane Warts: Flat warts that may appear on the face, arms, or legs.
Condylomata Acuminata: Genital warts that appear on the genital and anal areas.

Question 25

What is Condylomata Acuminata, and what causes it?

Answer 25

Condylomata Acuminata:

Also known as genital warts, it is caused by Human Papilloma Virus (HPV), primarily by low-risk types HPV 6 and HPV 11.
It manifests as cauliflower-like growths on the genital and anal areas.

Question 26

How does Mollusca Contagiosa present in HIV/AIDS patients?

Answer 26

In HIV/AIDS patients, Mollusca Contagiosa may present as:

Multiple, Confluent Lesions: Larger, more numerous, and persistent lesions compared to immunocompetent individuals.
Atypical Locations: Lesions can appear on the face, particularly around the eyes, as well as on the trunk and genital area.
Resistance to Treatment: Lesions may be more difficult to treat and have a higher tendency to recur.

Question 27

How is Mollusca Contagiosa managed in HIV/AIDS patients?

Answer 27

Management includes:

Topical Treatments: Trichloroacetic acid, tretinoin, or imiquimod cream can be used to reduce lesions.
Physical Removal: Curettage, cryotherapy, or laser therapy to remove lesions.
HAART: Initiation or optimization of antiretroviral therapy to improve immune function and reduce the severity and recurrence of lesions.
Regular Monitoring: Close follow-up to manage recurrences and prevent complications.

Question 28

What is Oral Hairy Leukoplakia (OHL), and what causes it?

Answer 28

Oral Hairy Leukoplakia (OHL):

A white, patchy lesion on the tongue, often with a “hairy” appearance.
Caused by Epstein-Barr Virus (EBV), typically in immunocompromised individuals, including those with HIV/AIDS.

Question 29

How does Cryptococcus neoformans infection present in HIV/AIDS patients?

Answer 29

Cutaneous Cryptococcosis: Skin lesions that resemble molluscum contagiosum, papules, nodules, or ulcers.

Question 30

How is Cryptococcus neoformans infection treated in HIV/AIDS patients?

Answer 30

Antifungal Therapy:
Induction Phase: Amphotericin B combined with flucytosine for at least two weeks.
Consolidation Phase: Fluconazole for at least eight weeks.
Maintenance Therapy: Long-term fluconazole to prevent relapse.

Question 31

How does scabies present in HIV/AIDS patients?

Answer 31

In HIV/AIDS patients, scabies may present as:

Severe Itching: Especially at night, often in areas like the wrists, elbows, fingers, and waistline.
Rash: Erythematous papules, vesicles, and burrows (small, thread-like tracks) visible on the skin.
Crusted Scabies: A more severe form, also known as Norwegian scabies, characterized by thick crusts on the skin that contain large numbers of mites.

Question 32

What is crusted (Norwegian) scabies, and why is it significant in HIV/AIDS patients?

Answer 32

Crusted (Norwegian) Scabies:

A severe form of scabies characterized by widespread, thick crusts on the skin.
Common in HIV/AIDS patients due to immunosuppression, leading to a higher mite burden and more severe disease.
Highly contagious and requires aggressive treatment.

Question 33

How is scabies treated in HIV/AIDS patients?

Answer 33

Treatment includes:

Topical Scabicides: Permethrin 5% cream applied to the entire body, often requiring repeated applications.
Oral Ivermectin: Used especially in cases of crusted scabies or when topical treatment fails.
Environmental Control: Washing bedding, clothing, and cleaning the living environment to prevent reinfestation.
Treatment of Close Contacts: All household members and close contacts should be treated simultaneously to prevent spread.

Question 34

What is the standard first-line HAART regimen for males over 30 kg and women aged 45 years or older in Malawi as of 2018?

Answer 34

The standard first-line HAART regimen is Regimen 13A which includes:

Tenofovir (TDF) 300 mg
Lamivudine (3TC) 300 mg
Dolutegravir (DTG) 50 mg

Question 35

What are some severe reactions associated with Nevirapine in the early stages of treatment, particularly when CD4 counts are above 250?

Answer 35

evere reactions to Nevirapine in the early stages of treatment include:

Stevens-Johnson Syndrome (SJS)
Maculopapular Exanthema
These reactions are more likely when the CD4 count is above 250.