Dermatological Conditions

Topical ketoconazole and miconazole can be used initially but systemic fluconazole or itraconazole may be used if topical therapy fails.  

Cryptococcus neoformans is the most common invasive fungal infection in PLWHIV. Cutaneous disease due to Cryptococcus is not seen in immunocompetent people. Cryptococcosis in PLWHIV is an AIDS-defining illness. (15) 

Approximately   10-20%   of   patients   with   HIV   infection   and cryptococcal infection have cutaneous lesions, which is a marker of disseminated infection. (95) These   lesions   can   have varying   morphologies   including: erythematous papules, nodules, pustules, ulcers, herpetiform vesicles, indurated plaques or subcutaneous swelling.  

Skin biopsy is often required to confirm cutaneous cryptoccocal infection. The diagnosis of cutaneous cryptococcal infection requires investigation for systemic disease. 

Cutaneous cryptococcosis without evidence of systemic involvement can be treated with oral fluconazole. If extracutaneous disease is found then the recommended treatment is intravenous amphotericin and flucytosine for at least 2 weeks, followed by oral fluconazole for at least 8 weeks. (21)  

Scabies  Transmission of Sarcoptes scabiei, the causative mite for scabies, occurs by direct skin-to-skin contact with a person who has the infection or via fomites. The likelihood of transmission is higher when the parasite burden in the affected patient is bigger. Transmission via inanimate objects, such as shared clothing, is rare, but may occur in …

Parasitic infections Read More »

Classic scabies presents as papulovesicular lesions. The distribution varies, favouring the wrists, interdigital web spaces, elbows, axillae, breasts and genitals. Predominantly night-time pruritus is usually present. Excoriation may lead to bacterial superinfection including impetigo, cellulitis and, in some cases, fatal sepsis. (98) In PLWHIV, both the classic form and generalised, crusted (Norwegian) scabies can occur. …

Clinical presentation Read More »

The diagnosis is usually clinical and may be assisted by dermoscopy. (100) Definitive diagnosis of scabies is by microscopic examination of skin scrapings in potassium hydroxide 10% solution, demonstrating mites, ova or faeces. The skin is scraped with a sterile blade and the skin sample is placed in mineral oil for transport. 

People  with  a  CD4  cell  count  over  200  cells/μL  usually respond  to  a single total body application of  topical  permethrin  (5%)  left on for 8 to 14 hours, and repeated after  1 week. If permethrin is not available, benzyl benzoate 25% emulsion applied for 24-36 hours may be used. The lotion is usually applied once …

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Seborrhoeic dermatitis  Seborrhoeic   dermatitis   is   a   very   common   non-infectious cutaneous presentation of HIV and is observed in 85% of patients with AIDS. (104)  Increased severity and extent of involvement with poorer response to treatment occurs with progressive immunosuppression. Malassezia  may have a role in the pathogenesis of this disease, with higher colonisation in patients with more severe …

Non-infectious disease Read More »