HIV and Skin Conditions

Original Editor - Rosie Swift

Top Contributors - Rosie Swift and Kim Jackson  

Introduction[edit | edit source]

Dermatological problems occur in more than 90% of people with Human Immunodeficiency Virus (HIV)[1]. HIV is a virus that attacks the body's immune system and, without treatment, will progress into Acquired Immune-Deficiency Syndrome (AIDS), which is characterised by opportunistic infections that are usually fatal if untreated. Several infectious, inflammatory, and neoplastic skin and mucosal conditions can affect individuals with HIV infection. Some of these conditions occur at specific stages of HIV infection[1], which can provide important information about the progression of the condition[2]. The prevalence, spectrum and severity of skin and oral conditions increases as the CD4 count declines below 200 cells/mm3 [3]. Although skin conditions are not a major cause of mortality, they provoke scratching, disfigurement, pain, sleep disturbance and psychological distress, which severely impacts the individual's life[3].

Aetiology[edit | edit source]

Some skin conditions typically experienced by individuals with HIV are opportunistic infections, in that they take advantage of a weakened immune system[4]. Other skin conditions result from an over active immune system in response to antiretroviral therapy (ART), or as a side effect of the drugs themselves[4].

Common types of skin conditions in HIV[edit | edit source]

Several skin conditions are pathognomonic of HIV/AIDS, these include Kaposi sarcoma, herpes zoster, papular pruritic eruption and extensive candidiasis[3]. Other conditions resemble more severe forms of common skin diseases, including seborrheic dermatitis and psoriasis, and the response to standard treatment may not be as expected.

  • Kaposi Sarcoma - Kaposi sarcoma causes purple or brown spots on the skin, and can affect internal organs including the lungs, liver, and parts of the digestive tract where they can cause potentially life-threatening symptoms and breathing problems. Karposi sarcoma only occurs when the CD4 count is extremely low and, as such, is an AIDS-defining condition. Antiretroviral drugs have greatly reduced the incidence and it generally responds to radiation, surgery, and chemotherapy.
  • Herpes Zoster - Herpes zoster viral infection is caused by the same virus that causes chickenpox and can cause an outbreak of sores around the genital area or the mouth. It can also result in shingles, an extremely painful blistering rash on one side of the body. It is treated using antiviral medication.
  • Papular Pruritic Eruption - Papular pruritic eruption is characterised by the eruption of itching papules on the extremities, face, and trunk; it is common during the advanced immunosuppressive stage of HIV[5].
  • Extensive Candidiasis - also known as thrush. Candidiasis is a fungal infection that causes a thick white layer to form on the tongue or inner cheeks. It can be managed with anti-fungal medications, mouth lozenges, and mouth rinses.
  • Seborrheic Dermatitis - Seborrheic dermatitis causes scaly patches, red skin and stubborn dandruff and usually involves the scalp, the face (eyelashes, eyebrows, and ears) and occasionally the chest, armpits, or groin. It is common in the HIV population. Treatment includes topical corticosteroids, tar shampoos and imidazole cream.
  • Molluscum Contagiosum - Molluscum contagiosum causes pink or flesh-colored bumps on the skin and is highly contagious, bing spread by skin to skin contact or simply by touching the same surface. It is treated using cryosurgery, laser or topical ointment.
  • Psoriasis - Psoraisis is an inflammatory condition that can cause skins changes. An estimated 5% of people with HIV infection will develop psoriasis and 10% of these will develop psoriatic arthritis. Psoriasis may arise shortly after a person begins antiretroviral therapy and is known as an immune reconstitution inflammatory syndrome (IRIS) and is as a result of an overactive immune system. However, in many cases antiretroviral therapy causes psoriasis to subside.

Treatment[edit | edit source]

Treatment differs depending on the skin condition that presents. Some skin conditions may respond differently to standard treatment when presenting in an HIV affected individual. Untreated HIV doubles the risk of skin disorders and, as such, persons with HIV should be placed on immediate antiretroviral therapy (ART) in order to block the virus' ability to replicate[3].

All adults, adolescents and children with unknown HIV status presenting with certain skin conditions, particularly those that are pathognomonic of HIV, should be offered testing for HIV immediately[3].

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Halder S, Banerjee S, Halder A, Pal P. Skin diseases in HIV-infected patients: Impact of immune status and histological correlation. Indian journal of sexually transmitted diseases and AIDS. 2012;33(1):65. Accessed 28 Jan 2022
  2. Tschachler E, Bergstresser PR, Stingl G. HIV-related skin diseases. The Lancet. 1996 Sep 7;348(9028):659-63. Accessed 28 Jan 2022.
  3. 3.0 3.1 3.2 3.3 3.4 World health Organisation. Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults [online]. 2022. Accessed 28 Jan 2022
  4. 4.0 4.1 John Hopkins Medicine. HIV/AIDS and Skin Conditions [online]. Accessed 28 Jan 2022
  5. Bellavista S, D'Antuono A, Infusino SD, Trimarco R, Patrizi A. Pruritic papular eruption in HIV: a case successfully treated with NB‐UVB. Dermatologic therapy. 2013 Mar;26(2):173-5. [Accessed 3 Feb 2022]