F

1. SKIN
MANIFESTATIONS
OF HIV/AIDS
SUMMARY

2. INTRODUCTION
 Up to 92% of HIV/AIDS patient will
have one or more skin disorders
during the course their illness.
 Recognizing HIV-related skin changes
may lead to the diagnosis of HIV
infection in the early stages, which
allows initiation of appropriate
antiretroviral therapy

3. INTRODUCTION
 Dermatological manifestations are
seen at every stage of HIV/AIDS
 Some of the conditions are unique
and virtually pathognomonic for HIV
disease like bacillary angiomatosis
and oral hairy leukoplakia.

4. HIV replication cycle and sites of drug activity
Capsid
proteins
and viral
RNA
CD4
Receptor
Viral RNA
New HIV
particles
Protease
Attachment Uncoating Reverse
Transcription
Integration Transcription Translation
Reverse
Transcriptase
Unintegrated
double stranded
Viral DNA
Integrated
viral DNA
Viral
mRNA
Integrase
gag-pol
polyprotein
1 2 3 4 5
6
Assembly and
Release
Protease Inhibitors
Indinavir (Crixivan)
Ritonavir (Norvir)
Saquinavir (Fortovase)
Nelfinavir (Viracept)
Amprenavir (Angenerase)
Lopinavir/ritonavir (Kaletra)
Atazanavir (Reyataz)
NRTIs
AZT (Zidovudine-Retrovir)
ddI (Didanosine-Videx)
ddC (Zalcitabine-Hivid)
d4T (Stavudine-Zerit)
3TC (Lamivudine-Epivir)
ABC(Abacavir-Ziagen)
FTC (Emtricitabine, Emtriva)
NNRTIs
Efavirenz (Sustiva)
Delavirdine (Rescriptor)
Nevirapine (Viramune)
Nucleus
Cellular DNA
CCR5
or
CXCR4
co-receptor
HIV Virions
nRTI
Tenofovir DF
(Viread)
T-20
(Enfuvirtide,
Fuzeon)

5. Acute Retroviral Syndrome
 80 percent of cases
 several weeks before seroconversion
 IP 3 to 6 weeks
 Constitutional symptoms are followed
by exanthematous rash.
 The more severe the ARS, the worse
the prognosis of AIDS will be.
 Some recommend giving HAART for 6
months to 2 years.

7. Seborrhoeic dermatitis
 The most common dermatosis
 The eruption, characterized by
widespread inflammatory and
hyperkeratotic lesions in seborrhoeic
areas, may progress to erythroderma.
 It is usually resistant to treatment

10. Xerosis
 Generalized dry skin syndrome is more
frequently observed in patients with
HIV infection.
 It is often accompanied by severe
itching.

15. Pruritic papular eruption (PPE)
 Common and relatively specific manifestation,
60% have advanced immunosuppression
 Small, itchy, red or skin-colored papules on
the head, the neck, and the upper part of the
trunk
 The cause is not known.
 Emollients, steroid and antihistamines give
temporary relief

21. Eosinophilic folliculitis
 An idiopathic, highly pruritic, papulopustular
eruption of sterile pustules around hair
follicles involving the face, the neck, the
trunk, and the extremities and occurring in
advanced immunodeficiency.
 May be the extreme of PPE.
 Resistant to all forms of treatment. Steroid
may help.

24. Bacterial infections
 Impetigo and folliculitis may be
recurrent and persistent in HIV
disease, particularly in children
 Disseminated furunculosis,
gingivitis, gangrenous stomatitis,
and abscess formation frequently
occur

28. Bacillary Angiomatosis
 Known to occur exclusively in HIV infection
 Caused by Bartonela quintana
 It presents as fleshy, friable, protuberant
papules-to-nodules that tend to bleed very
easily.
 Confuses with Kapos’s sarcoma and other
vascular tumors.
 Treatment consists of prolonged use of
antibiotics.

31. Fungal Infections
 Dermatophytosis has the same
frequency as the general
population, may be more
extensive and resistant to
treatment.

32. Fungal Infections
 Recurrent and severe
oropharyngeal candidiasis,
usually extending to the
esophagus and/or trachea is
the presenting symptom and
indicates immunosupression

33. Fungal Infections
 Deep and rare fungal infections like
cryptococcosis, coccidiomycosis, and
histoplasmosis affecting the systemic
organs and the skin are unique
features of advanced AIDS.

36. Oral Hairy Leukoplakia
 Very specific manifestation of HIV infection
presenting as filiform white papules or
plaques forming reticulate pattern on the
inferiolateral border of the mouth.
 It is due to Epstein-Bar virus infection.
 May be the initial sign of progressive
immunosuppression

40. Warts
 Lesions may be extensive and
resistant to therapy. warts usually look
like those seen in
nonimmunosuppressed patients, but
are more extensive.
 Flat warts on adult face are typical
features of HIV infection.

41. Warts
 Condyloma acuminata are of special
significance in persons with HIV
infection.
 They are very difficult to eradicate.
 Cervical dysplasia and carcinoma are
more frequent and invasive cervical ca
is a case defining illness.

42. Warts
 Condyloma acuminata are of special
significance in persons with HIV
infection.
 They are very difficult to eradicate.
 Cervical dysplasia and carcinoma are
more frequent and invasive cervical ca
is a case defining illness.

45. Herpes Simplex Virus
Infection
 Chronic persistent infection with herpes
simplex virus (HSV) is AIDS defining
illness.
 Ulceration and necrosis is the usual finding
with no prior history of blisters.
 Generalized forms with meningitis may
occur in advanced immunosupression.
 Prolonged treatment with intravenous
acyclovir is needed for extensive cases.

50. Herpes Zoster
 Commonly seen early in the course of
HIV infection, particularly in healthy-
appearing individuals
 May be particularly bullous, hemorrhagic,
necrotic, and painful
 Recurrences and multidermatomal
involvement is common
 Treatment need s systemic acyclovir

55. Chicken pox

56. Molluscum Contagiosum
 Occurrence of MC on the face of an
adult is an indication to screen for HIV
 They often number greater than 100
and may involve the face, trunk, and
groin
 Spontaneous healing is rare
 No hematogenous spread

60. Kaposi’s Sarcoma
 The first reported malignancy in
association with HIV infection
 Appears as red-to-brown flat macules
in any site, mainly above the trunk
 Prognosis is poor and kills the patient
unless HAART is instituted immediately

69. Scabies
 Frequency the same
 Norwegian (crusted) scabies, which is
characterized by wide spread
hyperkeratotic plaque occurs on palms
and soles.
 Prolonged treatment with repeated
course of scabicides is needed

73. Hypersensitivity Reactions
 The immune dysregulation associated
with AIDS has made these patients to
react abnormally for any exogenous
stimuli like arthropod bite, drugs, and
UV radiation

79. Hair and Nail Disorders
 Diffuse alopecia or alopecia areata
 Elongation of the eyelashes and
softening and straightening of the
scalp hair
 Beau’s lines
 Blue nails
 Proximal subungal onychomycosis