Dermatological Conditions

Patients have erythema and yellow-white greasy scaling of the sebaceous areas of the scalp, nasolabial folds, chest, back and intertriginous zone. The eruption is characterised by widespread, scaley, greasy, lesions and may progress to erythroderma. (106) 

Diagnosis is clinical.   Histological and microbiological assessment may assist differentiation from psoriasis, dermatophytosis or atopic dermatitis.  

Initial therapy includes clotrimazole cream, or anti-dandruff shampoos containing ketoconazole or selenium sulfide which can be applied to affected areas and washed off. (107).  Systemic therapy with oral antifungals or isotretinoin may be considered in severe cases.  

The underlying cause of xerosis in HIV is unknown; it may in part be linked to poor nutritional status, polypharmacy, chronic illness and immunosuppression. It is cited as affecting approximately 30% of PLWHIV. (108) Xerosis and ichthyosiform changes of the skin have been considered by several authors as a marker for disease progression as it …

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There are varying degrees of xerosis, but it is generally characterised by diffuse dryness of the skin with hyperpigmented scales and focal crusting.  (109)

Diagnosis is made on clinical assessment alone. Assessments of micronutrient status, such as vitamin A, B3, zinc and copper may be indicated. (110) 

Adequate nutrition is important.  Dry skin care regimens are effective in the management of this condition, with emollients, including those with urea, lactic acid or salicylic acid.  

Psoriasis is a common inflammatory skin condition which affects 2-5% of PLWHIV compared to a prevalence of 1-2% in the general population. (111) Population studies have suggested PLWHIV are at increased risk of developing incident psoriasis, although this has not been demonstrated in the Australian population. (112) Psoriasis is associated with several systemic conditions including psoriatic …

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Plaque psoriasis is characterised by well-defined, scaley and erythematous plaques which typically affects extensor surfaces. The erythema is classically described as ‘salmon pink’ in Caucasian patients, but may appear mulberry in darker skin tones. (114) Other clinical presentations include guttate psoriasis (diffuse small papules <10mm in diameter), erythrodermic psoriasis (involving >90% of body surface area), …

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The diagnosis of psoriasis is clinical. Biopsy confirm the diagnosis however is not typically required. (117). Due to the association between psoriasis and metabolic syndrome, (118) international guidelines have recommended screening of cholesterol, blood glucose levels and body mass index in all patients with psoriasis. (113)