HIV-infectious Disease & Cancer

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), …

Clinical presentation Read More »

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)

Spontaneous remission to complete unresponsiveness to all therapy has been described for HIV-related psoriasis, particularly following commencement of ART and normalisation of CD4+ counts. (119, 120) Topical therapy includes emollients, coal tar, salicylic acid, vitamin D analogs, and corticosteroids. Referral to a dermatologist is indicated in cases refractory to topical therapies, with significant body surface …

Management and prevention Read More »

Eosinophilic folliculitis (EF), previously referred to as Ofuji’s disease, is a common intensely pruritic condition often occurring in advanced HIV or the setting of IRIS, commonly 3-6 months post commencement of ART. (135)   Although some believe that eosinophilic folliculitis and pruritic papular eruption (PPE) are part of the same disease spectrum, the distribution of both …

Eosinophilic folliculitis, pruritic papular eruption and other inflammatory folliculitides Read More »

Eosinophilic folliculitis presents as intensely pruritic 2-3 mm erythematous oedematous urticarial papules centred on follicles and may have pustules. The distribution is typically over the forehead, neck, shoulders, trunk and upper arms. In women living with HIV, PPE may more predominantly involve the face and therefore mimic acne excoriae. (138) Due to the associated pruritus, …

Clinical presentation Read More »

The differential diagnosis is difficult and includes the common causes found in patients without HIV such as insect bite reactions, scabies, dermatitis herpetiformis, drug reactions, atopic dermatitis and bacterial folliculitis. Skin biopsy for histopathological assessment be helpful, however EF and PPE have overlapping histological features and thus should be used primarily to support clinical diagnoses. …

Diagnosis Read More »

Depending on the cause, management varies, particularly if an infective cause such as scabies is found. Eosinophilic folliculitis and pruritic papular eruption can be difficult to manage with the pruritus often unresponsive to traditional therapies. Case reports of both EF and PPE remission following commencement of ART have been reported. (139, 140) Treatment options for …

Management Read More »

Drug reaction, eosinophilia and systemic symptoms (DRESS) Drug reaction, eosinophilia and systemic symptoms (DRESS) is a rare severe cutaneous adverse reaction (SCAR) seen more commonly in PLWHIV. (143) DRESS can develop as a SCAR to medications, including ART agents such as abacavir or raltegrovir which demonstrate association with HLA genotypes HLA-B*57:01 and HLA-B*53:01, respectively. (144-146)

The disease is characterised by cutaneous eruption which can take on any morphology, fever, lympadenopathy and the presence of eosinophilia or atypical lymphocytes and solid organ inflammation on laboratory investigation. Common end organs affected include the heart, lung, kidneys and liver. Mortality approaches 20% if untreated, usually as a result of hepatotoxicity. (143)

The diagnosis is usually clinical, and may be aided by the REGISCAR scoring system. (147) Skin biopsies usually reflect the morphology of the cutaneous eruption but are not specific to DRESS. The eosinophilia may be delayed, developing days after the first skin signs are noted.