Diagnosis
A skin biopsy is usually obtained for definitive diagnosis given the morbidity and mortality associated with this condition. Severity scoring such as with the SCORTEN criteria may be helpful for prognostication. (153)
Management
Management
Stevens-Johnson syndrome has an attributable mortality of 5% and TEN an overall mortality of 30%. (153) If SJS/TEN is considered, patients should be transferred to a tertiary centre, and ideally one with an HDU/ICU or Burns Unit. Discontinuation of the offending drug is essential. Drugs initiated in the last 1 to 3 weeks before illness …
Pityriasis rubra pilaris
Pityriasis rubra pilaris (PRP) refers to a group of rare inflammatory skin disorders with clinical and histological similarities to plaque psoriasis. (130) There are six clinical subtypes, with Type VI, discussed herein, being proposed in 1995 as a unique HIV-associated dermatosis. (131) Due to its rarity and potential for misclassification as psoriasis, data on the …
Clinical presentation
Classic, Type I PRP is characterised by orange-red plaques with fine scale, which develops over weeks-to-months in a rostrocaudal fashion. Typical features which may differentiate it from psoriasis include keratotic follicular papules and ‘islands of sparing’, referring to areas of uninvolved normal skin interspersed between otherwise generalised plaques. (130) Erythroderma (with >90% body surface area …
Diagnosis
Diagnosis of PRP, including the HIV-associated Type VI subtype, relies on clinical findings and skin biopsy histopathological correlation. Up to 60% of PRP cases in retrospective studies were initially misdiagnosed as other inflammatory skin disorders, most commonly psoriasis, highlighting the diagnostic challenge in this disorder. (132)
Management
Among patients with PRP in the setting of newly diagnosed HIV infection, commencement of ART alone has been reported to induce cutaneous remission. (133, 134) Due to its rarity, management guidelines are based on retrospective studies and case series, and may include topical steroids, retinoids and vitamin D analogs in cases with limited cutaneous involvement, …
Mpox
Mpox, previously termed monkeypox, is an orthopoxvirus infection predominantely spread through sexual contact. In 2022 a global outbreak led to its declaration as a Public Health Emergency of International Concern by the WHO, with over 78,000 cases across 100 countries. (76) This outbreak disproportionately affected PLWHIV, who comprised approximately 40% of diagnosed cases. (77) To …
Diagnosis
The diagnosis of mpox requires confirmation by nucleic acid amplification testing (NAAT) using a sterile dry swab collected from lesional fluid or crust. Skin biopsy for NAAT and histopathological analysis can be helpful in patients without vesicles or crusts available to swab. (83)
Management and Prevention
Treatment of mpox is primarily supportive, with most cases resolving after three weeks. (76) Paraenteral nutrition and hydration may be required in patients unable to tolerate oral intake due to mucosal lesions. Antiviral treatments should be prescribed under the guidance of Infectious Diseases specialists, and may be required in severe cases or in patients with …
Cytomegalovirus and Epstein-Bar Virus
Other herpesviridiae including cytomegalovirus (CMV) and Epstein-Bar virus (EBV) do not typically present with chronic mucocutaneous lesions. In PLWHIV, mucocutaneous CMV infection is regarded as an AIDS-defining condition. (15) Clinical Presentation In PLWHIV and CD4+ count below 200 cells/μL, both CMV and EBV infection may result in chronic mucosal or perianal ulceration, correlating with the …