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Acquired Immunodeficiency Syndrome;
what skin can tell?
Almansouri Daifallah MD
– Acquired Immunodeficiency Syndrome
– An acquired defect of cellular immunity associated
with infection by the human immunodeficiency
virus (HIV), a CD4-positive T-lymphocyte count
under 200 cells/microliter or less than 14% of
total lymphocytes, and increased susceptibility to
Classification of skin diseases in AIDS
1- The disease itself; malignancy (6%).
– A) AIDS-defining cutaneous cancers e.g. KS
– B) non-AIDS-defining cutaneous cancers e.g.
SCC(anal), BCC, melanoma ( bad prognosis) HPV
tumor (anal or cervical).
2- Oppurtunistic infection;
viral, bact, fungal, parasitic.
Skin condition reflects AIDS progression
• Early stage; morbilliform eruption, condylomata
acuminata and verrucae.
• The immune system is compormised; recurrent
varicella zoster, treatment-resistant seborrheic
dermatitis, numerous hyperkeratotic warts, and
oral hairy leukoplakia.
• Late stage; 73% have CMV and HSV
• Advanced; Leishmaniasis and miliary
TB, PPE, Photosensitivity
34% has KAPOSI sarcoma
• Difinition; KSHV/HHV8 induced prolifiration of
endothelials > chronic inflammation >
• DP: prolifration of infected endothelial cells and
presence of immune cells.
• 3 sites; skin, lymphnodes, and viscera.
• Homosexual men; majority.
• Pink>palpable>brown> painful.
• Recover immunity> KAPOSI remission.
• Superficial: oral/viginal* candidiasis. Tx: oral
• Deep: cryptococcosis
(cellulitis, ulcers), histoplasmosis, blastomycos
*viginal candidiasis is commonest AIDS
presentation in US.
1 - M avium-intracellulare complex (MAC):
MOSTLY disseminated from else where.
2 - Syphlis: coinfection, ?diagnosis, presentation; typ vs
3 - Staph. aureus is the commonest
(impetigo, cellulitis), also MRSA is higher in
Seborrheic dermatitis: 83% Tx: SA, coal tar, Tacrolimus,
Xerosis: 4.5% Tx: emollients.
Psoriasis: trigger or bad prognosis.
ichthyosis: new onset+ HIV+ Drug abuse = human
lymphotropic virus II > profound helper T-cell
• Pruritic papular eruption (PPE): 81% have advanced
– Tx: steroids, UV-B, PUVA, and pentoxifylline
Hair and nails
• Alopecia; HIV itself or indinavir.
• Onychomycosis: common.
• Nail pegmentation: HIV itself or Zidovudine
• SJS/TEN: higher rate than general papulation - reported for: Fluconazole, Clindamycin and
antibiotics, Phenobarbital, Chlormezanone
• Trimethoprim-sulfamethoxazole for
Pneumocystis: mostly results in morbilliform
• Rull out AIDS in any pt ē resistant, generalised
or atypical fungal infection.
• Examine AIDS patient always for drug
• Staph. A is commenest bacterial infection.
• Vaginal candidiasis is commonest
• Kaposi sa is commonest malignancy and
improved when immunity recovered.