1.Dermatological manifestations of HIV/AIDS Mohammed Beyan/MD/ Dermatovenereologist ALERT

2. Introduction 40.3 million people were estimated to be living with HIV worldwide In 2005 Higher prevalence in sub-Saharan Africa of the global HIV/AIDS 3. Introduction Detection of HIV-associated dermatologic disease is therefore important guide to testing and diagnosis. 4. The skin, being visible and largest organ, often shows early manifestations of internal disease - this is true for HIV disease. Cutaneous disorders occur in nearly every patient during the course of HIV disease Up to 92% of HIV/AIDS patient will have one or more mucocutaneous disorders 5. Introduction No skin condition is specific for HIV infection However, During the course of HIV infection, Skin diseases tend to be more chronic, More severe, More resistant to conventional treatments and, Display unusual clinical presentations 6. Case group by CDC case definition of AIDS AIDS defining condition counts % Oropharyngeal candidiasi 189 75.6 % Wasting syndrome 186 74.4 % Epidemic KS 41 16.0 % Encephalopathy 29 11.6 % PCP 25 10.0 % H.Zoster 2 dermatoms 20 8.0 % Pneumonia recurrent 3 1.2 % Crytococal meningitis 1 .4 % 7. Seroconversion illness Acute primary HIV infection may lead to a transient, generalized, morbilliform eruption on the trunk and the arms. 8. Xerosis (dryness of the skin) and acquired ichthyosis: Generalized dry skin is frequently observed in more than 30% patients with HIV infection. often it is a cause of pruritus Starts on the lower extremities and becomes disseminate in advanced HIV disease Management Avoid frequent usage of soap and water Emollients & topical steroidsVaseline: paraffin 50%:50% Vegetable oil olive oil 9. Psoriasis The prevalence of psoriasis increased in HIV disease The onset may be before or after HIV infection -improves more with HAART than psoriasis that was present before HIV infection 10. Psoriasis It may develop at any stage of HIV infection . a rapid onset of 'eruptive' &severe psoriasis. The psoriasis is often severe and may be associated with significant nail dystrophy, arthritis and Reiter's disease. It tends to worsen with declining immune status. 11. Seborrhoeic dermatitis Observed in 85% - It may be the initial cutaneous manifestation of HIV disease widespread inflammatory and hyperkeratotic lesions in seborrhoeic areas may progress to erythroderma in some patients Management Steroids and antifungal agents Severity dectates the mode of treatment Extensive --- systemic treatment 12. Scabies Norwegian (crusted) Scabies Manifestations Mangemet 13. 2.Scabies Norwegian (crusted) scabies, which is characterized by wide spread thick hyperkeratotic scales &crust. Prolonged treatment with repeated course of anti scabicides is needed. 14. Treatment. Permethrin 5% cream Ivermectin 250to 400microgram/kg single dose. 15. Herpes Zoster Commonly seen early in the course of HIV infection. It is due to reactivation of the latent virus that resides in the dorsal ganglion of nerves. painful grouped vesicles which follows dermatomal distribution. Recurrences and multidermatomal involvement is common. 16. Herpes zoster Presentations Higher rate of Post herpes zoster neuralgia Complications Ocular complications Disseminated infection Bacterial super infection Post H. Zoster neuralgia Management 17. Herpes zoster 18. Treatment of herpes zoster Acyclovir 800mg po 5 times daily for 7days. The drug is effective only during the active stage of the disease. Complication :2ry bacterial infection,post herpetic neuralgia. 19. Exfoliative dermatitis Seborrhoeic dermatitis Atopic dermatitis psoriasis vulgaris, Photosensitivity dermatitis, drug hypersensitivity 20. HIV-associated malignancies Kaposi sarcoma - proliferation of endothelial cells induced by human herpesvirus type 8 (HHV-8). KS begins as pink macules that become disseminated and palpable. Purplish or brown macules and plaques may become nodular. Mucosal and internal organ involvement is common. The clinical progression of KS in patients infected with HIV is more aggressive than the other clinical types of KS 21. Kaposis Sarcoma Is a vascular hyperproliferative tumor Affects skin,GI,respiratory tract &CNS. Appears as bluish macules ,papules or nodules on the face,trunk or limbs. Prognosis is poor and kills the patient unless HAART started. 22. Distribution of Kaposis sarcoma Face 78 H ands/arm s only 1 Enlarged glands 66 O edem a of leg 47 M ucous m em branes 108 C onjunctiva 17 H ard palate 108 Tongue 15 B uccal m ucosa 9 G um s 19 Tonsils 11 W idespread lesions 97 O edem a of w hole body 3 Vulva 1 Feet/legs 138 Feet/legs & hand/arm s 25 U lcerated lesions 18 Uvula 1 Penis 4 23. Pruritic papular eruption (PPE) It is a chronic pruritic dermatosis occurring in persons with advanced HIV diseases PPE is asso. with low CD4 count (