Indian Journal of Sexually Transmitted Diseases and AIDS
ORIGINAL ARTICLE
Year
: 2007  |  Volume : 28  |  Issue : 1  |  Page : 19--22

Noninfectious cutaneous manifestations of HIV/AIDS


Ajay Sharma, Dipak Chaudhary, Megha Modi, Divyesh Mistry, YS Marfatia 
 Department of Skin and VD, Medical College and SSG Hospital, Vadodara, India

Correspondence Address:
Y S Marfatia
Department of Skin and V.D., Medical College and SSG Hospital, Vadodara
India

Abstract

Cutaneous manifestations of human immunodeficiency virus (HIV) infection or acquired Immunodeficiency syndrome (AIDS) can occur throughout all stages of infection. The dermatological complications of HIV and AIDS may be distressing to the patient and difficult for the dermatologist to diagnose and manage. The aim of this study was to examine the pattern of noninfectious cutaneous manifestations and their relationship with stage of HIV infection. Two hundred HIV-positive/AIDS cases attending Skin-STD clinic, Govt. Medical College, Vadodara, were thoroughly examined to find cutaneous manifestations. Skin, scalp and nails were thoroughly examined. One hundred twenty out of 200 cases had noninfectious cutaneous manifestations like pruritic papular eruption in 43 cases (35.8%), pigmentary changes in 10 cases (8.3%), seborrheic dermatitis in 5 cases (4.2%) and psoriasis in 4 cases (3.3%). Such presentations were more frequently observed in symptomatic/AIDS cases. Adverse drug reactions (ADRs) were observed in 15 cases. These include 6 out of 30 cases on antiretroviral therapy (ART) and 9 cases on other medications. Pemphigus vulgaris and acanthosis nigricans (AN) were seen as co-presentation, each in 1 case of AIDS. HIV-related cutaneous manifestations are very common and, if studied properly, can serve as diagnostic and prognostic markers. They may reflect involvement of internal organs. Many of the infectious and noninfectious manifestations respond well to antiretroviral therapy, which may not be feasible in resource-restricted setup.



How to cite this article:
Sharma A, Chaudhary D, Modi M, Mistry D, Marfatia Y S. Noninfectious cutaneous manifestations of HIV/AIDS.Indian J Sex Transm Dis 2007;28:19-22


How to cite this URL:
Sharma A, Chaudhary D, Modi M, Mistry D, Marfatia Y S. Noninfectious cutaneous manifestations of HIV/AIDS. Indian J Sex Transm Dis [serial online] 2007 [cited 2022 May 23 ];28:19-22
Available from: https://www.ijstd.org/text.asp?2007/28/1/19/35706


Full Text

 Introduction



Skin disease may provide the first suspicion for the diagnosis of human immunodeficiency virus (HIV) infection, may cause significant morbidity as the disease progresses and may point towards the diagnosis, with important systemic implications. The number of muco-cutaneous diseases, like the CD 4 T cell count, is a prognostic indicator of the development of AIDS and of overall survival. [1]

In general, HIV dermatology presents broad challenges to the dermatologist. There is an opportunity to make the initial diagnosis of HIV in patients with a seroconversion illness or with subtle or florid manifestations of one or the other dermatoses associated with underlying HIV infection. Severe cutaneous disorders occur frequently as HIV infection advances and immune function deteriorates. They affect between 80 and 90% of HIV-infected patients and occur at any time during the course of infection. [2] The common cutaneous presentation can be infections, noninfectious inflammation and neoplasms. Noninfectious manifestation can be seborrheic dermatitis, psoriasis vulgaris, Reiter's syndrome, xerosis and acquired ichthyosis, papular pruritic eruption (PPE) of HIV, etc. Seborrheic dermatitis is the most common noninfectious cutaneous manifestation. It is often the only sign of infection in early stage of immunosuppression and is seen in 50% of cases.

In developing countries, CD 4 count, viral load, etc., are used for assessment of HIV disease. Lack of these facilities or their high cost necessitates greater dependence on clinical markers. Cutaneous manifestations can serve as a dependable marker of HIV disease.

 Materials and Methods



The present study was carried out in the HIV referral clinic, Department of Skin-V.D., S.S.G. Hospital and Medical College, Baroda. Two hundred cases having muco-cutaneous manifestations were enrolled. Out of 350 cases tested HIV antibody positive by enzyme-linked immunosorbent assay (ELISA) on two occasions, 200 cases having muco-cutaneous manifestations suggestive of HIV infection/AIDS were enrolled. A detailed history of each case was taken. An attempt was made to know the possible mode of transmission of HIV infection in each patient and/or a history of any risk factor(s) in the spouse; and parents, in case of children.

History of fever, cough, breathlessness, diarrhea, weight loss, sexually transmitted diseases (past or present), skin lesions, mucosal lesions, pulmonary or extrapulmonary tuberculosis (past or present) was elicited in every case. Cases were thoroughly examined with regards to involvement of scalp, hair, nail, oral and genital mucosa, lymph glands and other systems.

All cases were advised hemoglobin, total count, differential count, erythrocyte sedimentation rate, urine albumin -sugar and micro, baseline weight, X-ray chest PA view, venereal disease research laboratory (VDRL), HBsAg, Mantoux test, ultrasonography of abdomen. If necessary, fine needle aspiration cytology was carried out. Patients were treated symptomatically. Specific treatment was given for muco-cutaneous opportunistic infections (OI). Cases were asked to come for follow-up every week initially, and monthly after clinical cure.

 Results



Two hundred cases were observed over a period of 2 years. One hundred twenty cases (60%) had noninfectious cutaneous manifestations. Most of these were observed in symptomatic and AIDS cases [Table 1]. Most common manifestation was PPE (35.8%) [Figure 1], followed by drug reaction (12.5%) [Table 2]. One case with psoriasis [Figure 2] presented with severe psoriatic arthritis. In one case each, AIDS case presented with pemphigus vulgaris and acanthosis nigricans as co-presentation [Figure 3],[Table 2]. In case of pemphigus vulgaris, there was severe affection of mucosae, and there was very slow response to systemic steroids.

Nail changes were observed in 10 cases (8.3%). Pigmentation of nail was the commonest nail change [Figure 4], followed by onychomycosis [Table 3]. Cutaneous drug reaction was observed in 15 cases (12.5%). Most common was maculopapular rash due to nevirapine. One case on nevirapine had grade IV rash (Stevens Johnson syndrome) [Table 4].

 Discussion



In the present study, the most common noninfectious cutaneous manifestation was PPE, in 35.8% cases; while Kumarasamy et al . and Maniar et al . reported PPE in 7.7% and 48% cases respectively. [3],[4] Hyperpigmentation of skin was more common (72%) in the study reported by Maniar et al. ; while in the present study, it was seen in 8.3% cases. [4] Nail hyperpigmentation in the present study was comparable to that in the study by Kumarasamy et al . [3] Pemphigus vulgaris, an autoimmune disorder, may improve with HIV disease progression. Therapy of the same with immunosuppressive drugs may cause HIV disease progression and may necessitate initiation of ART. Acanthosis nigricans may develop due to endocrinal/metabolic alterations occurring as a direct consequence of opportunistic infections, malignancy or therapy.

Drug reaction was more common in the present study than in the study by Kumarasamy et al . (12.5% vs . 1.32%). [3] All cases of drug rash were treated conservatively. In all cases with nevirapine sensitivity, nevirapine was replaced by efavirenz.

HIV-related cutaneous manifestations are very common and can be easily detected. If studied properly, they can serve as diagnostic and prognostic markers. Cutaneous adverse drug reaction may reflect involvement of internal organs. Many of the infectious and noninfectious manifestations respond well to ART.

References

1Bunker CB, Gotch F. AIDS and the skin. In : Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's textbook of dermatology. 7 th ed. Blackwell Publishing: Italy; 2004. p. 26.8-26.9.
2Thappa DM. Muco-cutaneaous manifestations of HIV infection and AIDS. In : Kumar B, Gupta S, editors. Sexually transmitted infections. 1 st ed. Elsevier Publications: New Delhi; 2005. p. 673.
3Kumarasamy N, Solomen S, Madhivanan P. Dermatological manifestations among human immunodeficiency virus patients in South India. Indian J Dermatol 2000;39:192-5.
4Maniar JK. The HIV/AIDS epidemic in India- the real challenge for dermatovenereologists in the new millennium, 29 th National Conference of IADVL: Agra; 1-4 February 2001.