Diagnosis
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.
Management
Management
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 …
Fungal infections
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
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 …
Candida infections
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 …
Diagnosis
The diagnosis of candidiasis is usually made clinically. Samples for microscopic examination and cultures are usually required when fungal resistance is suspected.
Management
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 …
Malassezia infections
Malassezia has seven different subspecies that cause or contribute to a spectrum of conditions, with M. symbodialis, M. globosa and M. furfur the most common species isolated. These are commensal organisms on normal skin, however show greater diversity and immunoreactivity in patients with HIV leading to greater likelihood of associated cutaneous manifestations. (95) Clinical presentation Malassezia can present in the …
Diagnosis
The diagnosis relies on a KOH preparation test from skin scrapings or swabs from pustules.
Treatment
Topical ketoconazole and miconazole can be used initially but systemic fluconazole or itraconazole may be used if topical therapy fails.