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INTRODUCTION

While significant progress has been made in global and regional HIV prevention and treatment programs, worrying trends are emerging in many parts of Asia particularly among men who have sex with men (MSM) where infection rates are rising. Many new cases present in late-stage HIV infection with CD4+ cell counts less than 200/mm3 or with AIDS-defining opportunistic infections. Skin disorders are extremely common especially with a lower CD4+ count and may cause substantial morbidity.

Cutaneous disorders in HIV-infected persons can be broadly classified into the following types:

  1. Inflammatory dermatoses

  2. Adverse drug reactions

  3. Pruritic skin conditions

  4. Neoplasms

  5. Infectious diseases

There are some differences in the clinical spectrum of skin diseases between Asian HIV-positive individuals and their Western counterparts. For example, the incidence of HIV-associated Kaposi’s sarcoma is lower in Asian patients, which may be explained by the smaller proportion of homosexuals and lower prevalence of human herpesvirus-8 (HHV-8) in Asians. This may change in the future, if the trend of HIV infection in MSM continues to rise.

Some Asian studies have noted a preponderance of inflammatory dermatoses, particularly pruritic papular eruption, psoriasis, and seborrheic dermatitis. Furthermore, regional differences in the pattern of cutaneous diseases exist. An example is infection with Penicillium marneffei, a dimorphic fungus endemic to South-East Asia and Southern China. This diagnosis must be considered in any skin eruption in this group of patients.

The increased availability of anti-retroviral therapy (ART) in Asia will result in more cases of adverse drug reactions to these medications and also immune reconstitution inflammatory syndrome (IRIS).

This chapter illustrates the wide spectrum of cutaneous disorders frequently encountered in HIV-infected persons.

INFLAMMATORY DERMATOSES

Seborrheic dermatitis affects up to 40% and 80% of patients with HIV and AIDS, respectively, compared to 4% of the general population (Figures 26–1, 26–2, 26–3, 26–4, 26–5, 26–6, 26–7, 26–8). Pinkish to red patches and plaques with greasy scales are typically concentrated around areas of increased sebaceous glands such as the face and scalp. HIV-seropositive patients often have more extensive and refractory disease involving the chest, back, axillae, and groin that may progress to erythroderma. Treatment includes low to medium potency topical corticosteroids, topical antifungals, oral antifungals, selenium sulfide, coal tar, and salicylic acid shampoos.

Figure 26-1

Seborrheic dermatitis

Erythematous patches with greasy scales are present on the nasolabial folds and cheeks. Seborrheic dermatitis is found in up to 40% and 80% of patients with HIV and AIDS, respectively. It may be the initial cutaneous manifestation of HIV infection, and it is usually more severe and less responsive to treatment in patients with greater immunosuppression.

Figure 26-2

Psoriasis

Extensive, thick, scaly plaques are present over the trunk and limbs. ...

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