Skin conditions are among the earliest predictors of the presence of HIV in the body, and are often viewed as markers for the disease’s progression. Approximately 90 percent of all HIV-infected individuals will present rash-like symptoms during the course of their disease. HIV-related rashes generally fall into one of three categories: generalized dermatitis; bacterial, fungal, viral, and parasitic infections; and skin tumors.
Generalized skin rashes are the most commonly experienced symptom of HIV. Among the primary types of generalized dermatitis seen among HIV infected patients:
- Xerosis: Approximately 20 percent of all HIV-infected individuals will experience xerosis, which can be described as general dryness of the skin. This form of skin dryness often affects the body’s extremities and presents with dry, itchy, and scaly skin patches. Treatment of xerosis includes topical moisturizers containing urea and topical steroids.
- Atopic dermatitis: This chronic inflammatory condition, often characterized with red, scaly, and itchy rashes, is seen in approximately 30 to 50 percent of HIV-infected patients. Typical treatment involves the application of topical steroids.
- Prurigo nodularis: Prurigo nodularis can be characterized as lumps on the skin that cause scab-like appearances and itchiness. This type of dermatitis is typically seen among patients with extremely compromised immune systems. Current treatment protocol includes topical steroids and antiretroviral drugs.
- Eosinophillic folliculitis: Characterized typically by itchy, red bumps centered on hair follicles, this form of dermatitis presents most frequently in patients in later stages of the disease’s progression. While it can appear on any bodily surface, it tends to cluster on the upper body. Current treatments include antiretroviral drug regimens to help restore the patient’s immune system, topical steroids, and antihistamines.
Bacterial, Fungal, Viral, and Parasitic Infections
A number of bacterial, viral, fungal, and parasitic infections impact HIV-infected patients during the course of their disease. The most commonly reported infections include herpes zoster, molluscum contagiosum, oral hairy leukoplakia, and thrush.
- Herpes zoster: Caused by the same underlying virus as household chickenpox, herpes zoster can cause shingles, characterized by painful skin rashes and bumps, in HIV-infected patients. Treatment often involves antiviral drug regimens.
- Molluscum contagiosum: Characterized by pink or flesh-colored bumps on the skin, this highly contagious skin virus often impacts HIV-infected patients. Repetitive treatments may be required to completely rid the body of these unwanted bumps. Current treatment options include freezing the bumps with liquid nitrogen, topical ointments, and laser removal.
- Oral hairy leukoplakia: This oral viral infection can be characterized as thick, white lesions that present on the patient’s tongue. Ongoing antiretroviral treatments will improve the body’s immune system and ability to rid itself of this virus.
- Thrush: This fungal infection causes a thick white layer on the tongue. This recurrent infection can be challenging to treat. Current options include antifungal medications, oral rinses, and oral lozenges.
Kaposi sarcoma, a form of cancer that impacts the lining of lymph nodes and/or blood vessels, is most recognizable as dark lesions that appear on the skin that are brown, purple, or reddish in color. This form of cancer can impact the patient’s lungs, digestive tract, and liver, and can cause shortness of breath, difficulty breathing, and swelling of the skin. Lesions often present when the white blood cell count of the patient drops dramatically; this is often a clinical sign that the diagnosis should be modified to AIDS and that the patient’s immune system is severely compromised. Kaposi sarcoma responds to chemotherapy, radiation, and surgery. Ongoing antiretroviral drug therapy has shown promise in reducing the incidence of this cancer in HIV-infected patients.
HIV-infected patients should expect to experience one or more of the aforementioned types of skin conditions and rashes. Your personal physician will assess the type of rash presenting, consider your current medications, and prescribe a treatment plan to alleviate the symptoms experienced.