When your body’s immune system is weakened by HIV, infections can develop. These infections may lead to skin conditions such as rashes, sores, and lesions.
Skin conditions can be among the earliest signs of the presence of HIV in your body. They’re often viewed as indicators of HIV’s progression.
About 90 percent of people with HIV will have rash-like symptoms during the course of their disease. These rashes usually fall into one of three categories:
- generalized dermatitis, or skin rashes
- infections, including bacterial, fungal, viral, and parasitic
- skin lesions
HIV usually progresses through three stages:
|1||acute HIV infection||The virus reproduces rapidly in your body, causing severe flu-like symptoms.|
|2||clinical latency||The virus reproduces very slowly, and you may not feel any symptoms at all. This stage can last 10 years or longer.|
|3||AIDS||Your immune system has been badly damaged by HIV. This stage causes your CD4 cell count to fall to 200 cells per mm3 (normal count is 500-1600 cells per mm3).|
You’re most likely to experience skin conditions during stage 1 and stage 3 of HIV. Fungal infections are especially common when your immune system is at its weakest, in the third stage. These infections are often called opportunistic.
Dermatitis is the most common symptom of HIV. Treatments normally include one or more of the following:
- antiretroviral drugs
- topical moisturizers
Some types of dermatitis include:
Xerosis is skin dryness, which often appears as itchy, scaly patches on your arms and legs. This condition is extremely common, even in people without HIV. It can be caused by dry or hot weather, overexposure to the sun, and even hot showers.
You can treat xerosis with moisturizers and lifestyle changes, such as avoiding long, hot showers or baths. More serious cases may require prescription ointments or creams.
Atopic dermatitis is a chronic inflammatory condition that often causes red, scaly, and itchy rashes. It can appear on many parts of your body, including the:
- inside of the knees and elbows
It affects about 30 percent of the U.S. population, and it appears to be more common in dry or urban environments.
Atopic dermatitis can be treated with corticosteroid creams, skin-repairing creams known as calcineurin inhibitors, antibiotics for infections, or anti-itch medications.
Eosinophillic folliculitis is characterized by itchy, red bumps centered on hair follicles in the scalp and upper body. This form of dermatitis is found most frequently in people in later stages of HIV progression.
This condition is common during antiretroviral drug therapy, when your immune system becomes hyperactive.
Prurigo nodularis is a condition in which lumps on the skin cause itchiness and a scab-like appearance. It mostly appears on your legs and arms.
This type of dermatitis affects people with extremely compromised immune systems. Itching can become so severe that repeated scratching causes bleeding, open wounds, and further infection.
You can treat prurigo nodularis with steroid creams or antihistamines. In severe cases, your doctor may recommend cryotherapy (freezing the lumps). You may have to take antibiotics for infections caused by intense scratching.
Warts are growths on the top layer of skin. They are caused by the human papillomavirus. They usually resemble bumps with black dots on them (known as seeds). These are commonly found on the back of your hands, your nose, or the bottom of your feet.
Warts can be treated with a few procedures, including freezing or removal via minor surgery. However, HIV makes it much harder for your immune system to get rid of warts and prevent them in the future.
A number of bacterial, fungal, viral, and parasitic infections affect people with HIV. The most commonly reported infections include:
Treatment often involves antiviral drug regimens.
Molluscum contagiosum is characterized by pink or flesh-colored bumps on the skin. This highly contagious skin virus often affects people with HIV. You may need repetitive treatments to completely rid your body of these unwanted bumps.
Bumps caused by molluscum contagiosum are usually painless and tend to appear on the:
- upper body
Current treatment options include freezing the bumps with liquid nitrogen, topical ointments, and laser removal.
Oral hairy leukoplakia
Oral hairy leukoplakia is a viral infection characterized by thick, white lesions on the tongue.
Ongoing antiretroviral treatments will improve your body’s immune system and ability to rid itself of this virus.
This recurrent fungal infection causes a thick white layer on the tongue. It can be challenging to treat.
Current treatments for thrush include antifungal medications, oral rinses, and oral lozenges.
Kaposi sarcoma is a form of cancer that affects the lining of lymph nodes or blood vessels. It appears as dark brown, purple, or reddish skin lesions. This form of cancer can affect the lungs, digestive tract, and liver. It may cause shortness of breath, difficulty breathing, and swelling of the skin.
These lesions often appear when the white blood cell count drops dramatically. Their appearance is often a sign that HIV has turned into AIDS, and that your immune system is severely compromised.
If you have HIV, you’ll probably experience one or more of these skin conditions and rashes.
Some common HIV medications can also cause rashes, including:
- non-nucleoside reverse transcriptase inhibitors, such as nevirapine
- nucleoside reverse transcriptase inhibitors (NRTIs), such as abacavir
- protease inhibitors, such as tipranavir or fosamprenavir
Based on your environment and the strength of your immune system, it’s possible to have more than one of these conditions at the same time. Your treatment might need to address them individually or all at once.
Discuss your symptoms with your doctor if you have a rash. They’ll assess the type of rash you have, consider your current medications, and prescribe a treatment plan to relieve your symptoms.