Transcript of HIV AND THE SKIN. Seborrhoeic dermatitis Only 1-3% of the general population have seborrhoeic...
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- HIV AND THE SKIN
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- Seborrhoeic dermatitis Only 1-3% of the general population have
seborrhoeic dermatitis compared with 20-85% of patients with HIV.
Seborrhoeic dermatitis is commoner in seropositive than in
seronegative homosexual men. its severity is increased at CD4
T-cell counts below 100.Itchy, scaly patches are found at the
classical sites for seborrhoeic dermatitis. Management follows
conventional lines: emollients, topical steroids and antifungals
and oral imidazoles.
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- Drug reactions Of patients with Pneumocystis jiroveci pneumonia
treated with co-trimoxazole, 60% experience fever, nausea, vomiting
and a rash. Xerosis and cheilitis are common with PIs.
Lipodystrophy, retinoid-like effects particularly
indinavir-paronychia, periungual pyogenic granuloma-like lesions,
xerosis and cheilitis, and curly hair Zidovudine:trichomegaly,
alopecia,nail Pigmentation, Longitudinal melanonychia
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- Bacilary angiomatosis caused by the Gram-negative cat-scratch
disease organism Bartonella (previously Rochalimaea) henselae
affecting the skin. presents with purple, papular and nodular
vascular lesions resembling KS. Diagnosis is achieved by skin
biopsy. Bacillary angiomatosis responds to oral erythromycin in
most patients; isoniazid, rifampicin, ethambutol or clofazimine,
either in addition to or instead of erythromycin, have also been
used.
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- Candidosis. Oral candidosis has classically been associated
with immunosuppressive states and was one of the first features to
be recognized in the early days of the HIV epidemic before the
syndrome was clearly defined and the causative agent identified.
Oesophageal candidosis is an AIDS-defining diagnosis. Scabies has
been endemic in the HIV population and there are occasional
epidemic outbreaks on HIV wards, in hospices and in the community.
Transmission is by sexual intercourse, nursing, comforting and
massage. Norwegian/crusted scabies is highly contagious and its
diagnosis should arouse suspicion of underlying HIV infection.
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- Kaposi's sarcoma KS is caused by infection with human herpes
virus (HHV)-8 (KSHV). It is probably transmitted sexually, more by
the faecooral route or the ejaculate than by blood, in HIV-positive
homosexual men. HIV / AIDS-related KS may be a disseminated disease
with gastrointestinal and pulmonary involvement. Cutaneous KS is
multicentric and often involves the face, oral mucosa, palate and
genitalia.
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- Oropharynx Distressing mouth ulceration occurs frequently. The
differential diagnosis includes malignancy (KS and lymphoma),
HSV,CMV, fungal infections, Behcet's disease, drug-induced
ulceration(e,g. didanosisne-ddI, DDI), and idiopathic aphthous
ulceration. Oral candidosis is very common in HIV-positive
individuals and almost universal in AIDS. Hairy leukoplakia is a
new clinical entity that has emerged during the HIV epidemic and is
probably associated with EpsteinBarr virus infection. It is usually
asymptomatic, although patients have often noticed the appearance
of a roughened patch along the lateral margin of the tongue. is now
known to occur in other immunocompromised people and has even been
reported in healthy individuals.
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