Dermatologic Manifestations of HIV Infection

Posted by e-Medical PPT Friday, April 6, 2012
As pts immune reconstituted, decreased incidence of most of the diseases-seborrheic dermatitis, fungal diseases, psoriasis, opportunistic infections with skin manifestations.

Psoriasis
With ART, HIV psoriasis easily controlled with topicals (clobetasol and calcipotriene) and ultraviolet light.
Until ART kicks in or for more complex psoriasis-acitretin 10-25 mg /day

Photodermatitis
HIV makes pts sensitive to the sun
Pts with CD4 under 200 on photosensitizing drugs
Either ART allows pts to go off photosensitizing drugs or immune reconstitution decreases reaction
Tx: sunscreen, tx the dermatitis with potent topical steroids and lubricants, doxepin 25 mg qhs (as antihistamine)

Prurigo Nodularis
Pts consumed by itch
CD4 50 and under
May be a photocomponent to this
ART helpful
Potent topical steroids
Thalidomide

Molluscum
Seen frequently in young women not on ART
1st line therapy is ART
Liquid nitrogen only temporary
Curretage of large molluscum

Is KS in this category
KS seen throughout spectrum of CD4 counts (0-800)
First line therapy is ART-do you start ART is pts with KS who have high CD4 count?
Seeing KS erupting in persons on ART with excellent control-why?
Do they have abnormal function of T cells in spite of high CD4 counts?

Cutaneous Lymphoma
See it in CD4’s under 200
Work-up necessary to R/O systemic lymphoma
If just cutaneous, radiotherapy or surgery
Before ART era, cutaneous lymphoma had tendency to metastasize
Improves with ART (limited experience)

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