Clive Anderson - AT THE DERMATOLOGIST DISORDERS OF the skin are often the first sign of HIV infection. Ninety-two per cent of HIV-infected patients will develop one or more skin diseases during the course of the disease.
SEROCONVERSION ILLNESS
Between 50 and 70 per cent of patients are estimated to have an acute syndrome occurring two to six weeks after becoming infected with HIV. Only 25 per cent of these patients have symptoms severe enough to cause them to seek medical attention. The symptoms are fever, generalised joint pains, headaches, sore throat and swelling of the lymph glands.
The skin rash of the acute infection occurs in 25 per cent of patients and is usually red, flattened spots or bumps all over the body and on the palms and soles. These signs and symptoms go away in two to three weeks.
EARLY AND INTERMEDIATE STAGES
Skin disorders at early and intermediate stages of the disease occur earlier in the disease while the immune system is still strong.
Seborrhoeic eczema is seen in 85 per cent of HIV infected patients, affecting the scalp, face, neck, axillae and groin.
Dry, itchy, scaling skin occurs in 25 to 30 per cent of infected individuals and may become very severe, resembling fish scales.
Shingles, which is due to reactivation of the chicken pox virus, in a HIV-infected person is more widespread than usual, affecting larger areas of skin and there is a greater risk of complications.
Infection with warts caused by the Human papilloma virus occurs more frequently in HIV-infected persons. The lesions may occur on the hands, face and the mouth. Genital warts are also common and are more difficult to treat. Recurrences are frequent.
Itchy bumps (papulopruritic eruption) occur often in our patient with HIV infection. The itchy bumps appear on the outer aspects of the arms and hands and on the trunk. The condition is chronic and waxes and wanes.
Skin disorders with advanced disease tend to occur when the immune system is severely weakened.
ADVANCED DISEASE
Oral Candidiasis or thrush occurs in 90 per cent of patients at some stage of the disease. It appears as thick white exudates in the mouth and throat. It may also present as cracks at the sides of the mouth. Thrush can cause a soreness of the mouth, tongue and throat and occasionally, difficulty in swallowing.
Oral hairy leukoplakia is the name given to fuzzy patches that may appear on the side of the tongue. It is believed to be caused by a member of the Herpes virus family. The lesion usually does not cause any symptoms. Itchy wheals and bumps appearing around the hair follicles that involve the face and central trunk are called Eosinophillic folliculitis.
Despite treatment the itching is often persistent and severe. Skin cancers like Kaposi's sarcoma, an abnormal growth of blood vessels, are more common in men with HIV who have had sex with men and are thought to be at least partially due to a virus that can be sexually transmitted.
It is important to remember that most of these conditions do also occur in persons who are not HIV-infected. In HIV-infection, however, they are often more severe and difficult to treat. In persons presenting with a skin problem their HIV status should be checked if:
The patient has a florid or atypical presentation of a common disorder
The skin condition is resistant to conventional therapy
The presenting skin disorder is known to be related to HIV/AIDS such as Herpes zoster (shingles) in a young, otherwise well adult
There are risk factors for HIV such as a sexually transmitted infection
The patient presents with an AIDS-defining illness such as Kaposi's sarcoma.
Besides the specific treatment of the particular skin disorder, anti retroviral therapy, which acts to reduce the viral load and strengthen the immune system, does result in improvement of the skin conditions.
Dr. Clive Anderson is a Dermatologist and Venereologist.
