Treatment of cutaneous and anogenital warts is directed on the alleviation of signs and symptoms with traditional treatment modalities focusing on the destruction of infected tissue. First-line treatments for warts include cryotherapy or keratolytics such as topical salicylic acid-based preparations, either separately or in combination. (53) Refractory warts may require referral for off-label therapies, such …
Molluscum contagiosum (MC) virus is a poxvirus that causes a localised cutaneous infection most often seen in children. MC is spread by direct skin-to-skin contact, occurring anywhere on the body except the palms of the hands and soles of the feet. In people living with HIV, prevalence of MC has been reported to be as …
Clinical presentation Classically, MC presents as dome shaped, flesh-coloured 2-6 mm papules with central umbilication (70) In PLWHIV who are virally suppressed, MC lesions may not differ clinically to people without HIV, whereas in advanced HIV can be more numerous, larger and verrucous in morphology. (71, 72) .
The diagnosis of MC is usually clinical although a biopsy of the papules may be required if alternate diagnoses (eg mpox, cutaneous cryptococcus, talaromycosis, histoplasmosis) are being considered.
MC is usually self-limiting and spontaneously resolves after a few months in immunocompetent hosts, supporting a watchful waiting approach. (70) In the setting of advanced HIV immunodeficiency, recalcitrant lesions often improve with immune reconstitution on ART. (73) General advice about the risks of autoinoculation and spreading should be given. Genital lesions should be definitively treated …
Dermatophyte infections Dermatophytosis is most commonly due to Trichophyton rubrum, Trychophytum mentagrophytes or Microsporum canis. Patients living with HIV are not at increased risk of dermatophytosis, including those with advanced infection or low CD4+ counts. (88) Clinical presentation Cutaneous dermatophyte infection may affect the inguinal areas (tinea cruris), scalp (tinea capitis), body (tinea corporis) or nails …
Management of dermatophytoses does not differ for PLWHIV. Superficial disease can be initially treated topically. In children and adults (including pregnant women), localised tinea infections may be treated with topical terbinafine or miconazole. However, if this fails or if there is widespread, nail or dermal disease, systemic antifungal therapy is recommended. Duration of treatment depends …
Clinical presentation Oral candidiasis is the most common presentation of candida infection, presenting as white, exudative, plaques on the tongue, and oral mucosa. It can also present as the erythematous/atrophic erythematous form without white plaques which is often missed. (92) Other presentations include angular cheilitis with erythema and white scale, and chronic hyperplastic candidiasis with …
The diagnosis of candidiasis is usually made clinically. Samples for microscopic examination and cultures are usually required when fungal resistance is suspected.
Intraoral therapies such as nystatin or amphotericin lozenges are often used initially for oral candidiasis, topical clotrimazole for cutaneous candidiasis, and clotrimazole or miconazole pessaries for VVC. (92, 93) Systemic antifungal therapy may be required in refractory cases or in immunocompromised patients; fluconazole is the agent of choice at a dose of 150 mg single …
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