Guidelines

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the spectrum of SCAR. The incidence is higher in patients with HIV infection than in the general population due to higher rates of polypharmacy and underlying immune dysregulation. (149, 150) There have been well documented case reports of Stevens- Johnson syndrome and TEN in …

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Patients with SJS/TEN may present with a prodrome of fever, stinging eyes, painful swallowing, followed by development of dusky macules which progress to erosions and bullae. Epidermal detachment is common, which may lead to massive fluid loss and electrolyte imbalance. Any mucosal surface may be affected including the eyes, aerodigestive tract and genitalia. SJS is …

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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)

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 …

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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 …

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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 …

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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)

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, …

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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 …

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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)