Cutaneous manifestations are common in HIV patients, occurring in over 90% of cases. They can represent the first signs of HIV infection and have prognostic significance. Skin conditions in HIV patients often present atypically with lesions in unusual sites, atypical morphology, being more extensive or not responding to conventional treatments. Common manifestations include generalized rashes, oral/genital ulcers, seborrheic dermatitis, psoriasis, papulopruritic eruptions, eosinophilic folliculitis, granuloma annulare, bacterial/viral infections like herpes, fungal infections, and Kaposi sarcoma. It is important to consider HIV when patients present with rare or unusual skin
7. ▶Pruritis and xerosis
▶Pigmentation disorders-
hyperpigmentation
hypopigmentation
▶Inflammatory disorders-
seborrheic dermatitis
psoriasis
granuloma annulare
eosinophilic folliculitis
PPE
Classification
8. ▶Infections
Bacterial –Staph, strep, TB, syphilis, bacillary
angiomatosis
Viral- HSV HZV HPV Molluscum
Fungal- superficial and deep
Parasitic- scabies
▶Malignancy
▶Drug induced- drug rash
9. ▶ENUMARATE THESE DISORDERS AND WRITE
▶ATYPICAL SITE
▶ATYPICAL MORPHOLOGY
▶EXTENSIVE LESIONS
▶DONOT RESPOND TO CONVENTIONAL
TREATMENT
▶LONGER DURATION OF TREATMENT
REQUIRED
29. DERMATOPHYTOSES
▶Common in HIV , More prevalent in MSM-even
without HIV
▶Tinea cruris , Tinea corporis, Tinea pedis ,
onychomycosis
▶Widespread dermatophytoses NOT common in HIV
30. ➢Atypical morphology
➢Lesions have little inflammation and often lack the
elevated border
➢Atypical presentations like deep , invasive
dermatophytosis , Majocchi’s granuloma
➢Atypical sites
➢Penis scrotum
➢Tinea capitis in adults –could be a sign of HIV
33. ▶Both HSV 1 and 2 are common
▶Atypical, extensive ,respond poorly to conventional
treatment
▶Large deep ulcers
▶Chronic herpetic ulcers of longer than 1 month
duration- AIDS defining illness
HERPES SIMPLEX VIRUS
34. ▶Varicella / chicken pox
↖Prolonged course
↖Lesions may be Verrucous
↖Complications- pneumonitis, meningitis,bacterial
infections
VARICELLA ZOSTER INFECTION
35. ➢ Herpes zoster
-occurs in younger age group in HIV patients
-Can present as atypical forms
Multidermatomal HZ
Disseminated HZ
Verrucous lesion
necrotic or ulcerative lesions
-systemic complications like fulminant hepatitis and acute
meningoencephalitis
-recurrences are common
36. ▶Atypical in location, morphology, and size
▶Extensive ,giant , warty , Extragenital sites(FACE)
MOLLUSCUM CONTAGIOSUM
42. KAPOSI SARCOMA
▶Caused by HHV 8
▶AIDS DEFINING
▶ purple to brown patch,
plaque or nodule, which
may ulcerate
▶Lower extremities ,face
and oral cavity
▶In HIV -multicentric
43. ▶Primary skin malignancies are most common NADCs
▶SCC: BCC in HIV infected individuals is 1 : 7
▶SCC may present atypically, at a younger age, at
unusual sites (e.g. the nail fold) and be multifocal and
aggressive
NON AIDS DEFINING CANCERS
44. ➢Melanoma- present atypically and behave more
aggressively. May occur as benign macules or multiple
naevoid lesions.
47. ▶Therefore, a prior drug reaction does not constitute
an absolute contraindication to continued or further
treatment with a particular drug.
▶ART
◦Pruritis
◦Rash
◦SJS/TEN
49. TAKE HOME MESSAGE
ALL skin diseases in HIV patients in general
have
▶Unusual sites
▶Unusual presentations
▶Refractory to conventional therapy
▶Longer duration of treatment required
▶Continue ART