Non-Infectious Cutaneous

Manifestations Of HIV

-Reshma Ann Mathew

Disorders of epidermal cell kinetics- Seborrheic dermatitis, Psoriasis, Reiter’s

syndrome, Ichthyosiform dermatoses ( Xerosis )

Papular and follicular eruption of HIV- Pruritic Papular eruption

Pigmentary disorders- Hyperpigmentation, Vitiligo

Non Infectious Dermatoses

Adverse cutaneous drug reactions

Neoplasms- Kaposi’s sarcoma, lymphoma, melanoma

Miscellaneous dermatoses- Pityriasis rubra pilaris, idiopathic

thrombocytopenic purpura, pityriasis rosea, photosensitivity

Observed in 85% - It may be the initial cutaneous manifestation of HIV disease

Involves hairy region of scalp, face, axillae and pubic region.

Histologically- inflammatory changes & keratinocyte necrosis at dermoepidermal junction

Management-Topical steroids and oral Imidazoles (antifungal agents).

Seborrhoeic dermatitis

Pre-existing psoriasis may worsen and form guttate lesions, plaques or pustules or become erythrodermic.

Occur on extensor surfaces and scalp

Management-Standard topical therapy, systemic retinoids.

Psoriasis

Xerosis or Acquired Ichthyosis is frequently observed in more than 30% patients with HIV infection.

It is often accompanied by severe generalized itching.

Starts on the lower extremities

Histologically- hyperkeratosis with a thin granular layer

Ichthyosiform dermatoses

PPE is asso. with low CD4 count (<100 cells/pl)

It is characterized by marked pruritus and a greater involvement of the extremities than the trunk or face.

Clinically, the eruptions are follicular or non-follicular lesions (papules, pustules and nodules)

often with secondary change(excoriation, prurigo nodularis)

Pruritic papular eruption (PPE)

Cutaneous hyperpigmentation is frequently seen in late stage HIV

It is associated with oral pigmentation and involvement of palms.

Hyperpigmentation

It is high in untreated HIV and increasing immunodeficiency

The commom drug reaction patterns seen are-1) Toxic epidermis necrolysis(TEN), Steven

Johnson Syndrome(SJS)2) Genital and Oral ulcers 3) Systemic reactions, including fever,

leukopenia, thrombocytopenia, hepatitis, and nephritis

Adverse Cutaneous Drug reactions

It is the most common neoplastic complication of HIV

begins as pink macules that enlarge and become palpable.

They grow into purplish or brown plaques which may become hemorrhagic and nodular.

Common sites are trunk, leg, arm, face and oral cavity.

Kaposi sarcoma

Pityriasis rubra pilaris- characterized by reddish orange scaling,

plaques and keratotic follicular papules

Miscellaneous Dermatoses

Idiopathic thrombocytopenic purpura-

non palpable petechiae

Pityriasis rosea- malaise, fever with typical rash