HIV-Related Dermatoses

HIV-Related Dermatoses - Immune Meltdown Manifestations

• Core: Progressive ↓ CD4+ T-cell count → immune dysregulation & opportunistic conditions.
• Manifestations reflect CD4 strata:
  • Early (>500/µL): Seborrheic dermatitis, xerosis.
  • Intermediate (200-500/µL): Oral hairy leukoplakia (OHL), candidiasis, herpes zoster.
  • Late (<200/µL): Kaposi sarcoma (KS), eosinophilic folliculitis, extensive molluscum.
• Key Groups:
  • Infections (viral, fungal, bacterial)
  • Inflammatory dermatoses
  • Neoplasms (KS, lymphoma)
  • Adverse drug reactions

⭐ Kaposi sarcoma (KS), linked to HHV-8, is an AIDS-defining illness, typically appearing when CD4 count < 200 cells/µL.

HIV-Related Dermatoses - Viral & Fungal Frenzy

• Viral Infections:
  • Herpes Zoster (VZV): Often severe, multidermatomal, chronic, or disseminated. ↑ risk if CD4 < 200 cells/µL. May present as atypical, persistent lesions.
  • Molluscum Contagiosum (MCV): Numerous, giant (>5mm), persistent lesions, often facial or anogenital. Common if CD4 < 100 cells/µL.
  • Oral Hairy Leukoplakia (OHL): EBV-induced. White, corrugated, non-removable plaques on lateral tongue. Not premalignant.

    ⭐ OHL is highly specific for HIV infection and often an early sign of immunosuppression (CD4 < 400 cells/µL).

• Fungal Infections:
  • Candidiasis:
    • Oral thrush: White, removable plaques. Angular cheilitis.
    • Esophageal: AIDS-defining. Dysphagia, odynophagia.
    • Vulvovaginal: Persistent, recurrent, severe.
  • Cryptococcosis (Cutaneous): Umbilicated papules/nodules (MCV-like), plaques, ulcers. Sign of dissemination. Usually CD4 < 100 cells/µL.
  • Histoplasmosis (Disseminated): Varied skin lesions (papules, pustules, ulcers, molluscum-like). Usually CD4 < 150 cells/µL. 📌 Remember "Histo Hides" in macrophages!

HIV-Related Dermatoses - Bacterial & Inflammatory Blitz

• Bacterial Infections:
  • Bacillary Angiomatosis (BA): Bartonella henselae/quintana (CD4 < 200/µL). Friable vascular papules/nodules. Rx: Erythromycin or Doxycycline.
  • Staphylococcal Infections: Most frequent. Folliculitis, furuncles, impetigo. ↑MRSA risk.
  • Syphilis: Atypical, accelerated course (malignant syphilis). ↑Neurosyphilis.
• Inflammatory Dermatoses:
  • Seborrheic Dermatitis: Very common, often severe, widespread.

    ⭐ Severe or explosive-onset seborrheic dermatitis can be an early cutaneous marker of HIV infection.

  • Psoriasis: New onset or exacerbation; often severe (erythrodermic, pustular).
  • Eosinophilic Folliculitis: Intensely pruritic papules/pustules (face, trunk). CD4 < 250-300/µL. Peripheral eosinophilia.
  • Pruritic Papular Eruption (PPE): Chronic itchy papules (extremities, trunk). CD4 < 200-300/µL.
  • Drug Reactions: High incidence (TMP-SMX, NNRTIs). Morbilliform common_

HIV-Related Dermatoses - Alarming Skin Changes

• Kaposi Sarcoma (KS)
  • HHV-8 associated vascular neoplasm.
  • Macules, papules, plaques, nodules; violaceous/brown.
  • Oral, GI, pulmonary involvement common.
  • Diagnosis: Biopsy (spindle cells, neovascularization, extravasated RBCs).
  • 
• Non-Hodgkin Lymphoma (NHL)
  • ↑ risk, often extranodal (CNS, GI, skin).
  • Skin: nodules, plaques, ulcers; B-cell > T-cell.
• Squamous Cell Carcinoma (SCC)
  • ↑ risk, esp. anogenital (HPV-related) & sun-exposed areas.
  • Aggressive course.
• Severe Cutaneous Adverse Reactions (SCARs)
  • ↑ incidence with certain drugs (e.g., sulfonamides, nevirapine).
  • Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN).
  • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

⭐ Exam Favourite: Kaposi Sarcoma is the most common malignancy in HIV-infected individuals, often presenting with characteristic violaceous skin lesions, and its incidence has significantly decreased with effective antiretroviral therapy (ART).

High‑Yield Points - ⚡ Biggest Takeaways

• Kaposi sarcoma (HHV-8): AIDS-defining violaceous lesions.
• Oral hairy leukoplakia (EBV): White, non-scrapable plaques on lateral tongue; indicates immunosuppression.
• Severe seborrheic dermatitis: Common, often atypical presentation.
• Eosinophilic folliculitis: Intensely pruritic papules, especially on trunk/face.
• Herpes zoster: Often severe, recurrent, or multidermatomal.
• Molluscum contagiosum: Can be widespread, giant, or facial.
• Bacillary angiomatosis: Bartonella infection; mimics Kaposi sarcoma, biopsy needed for differentiation.