There are many types of skin diseases that can affect a person irrespective of their HIV status. Similarly, HIV-positive patients are prone to various skin diseases that are unrelated to HIV infection. However, there are number of HIV-related skin diseases that have to be considered as these conditions are more likely to arise with the immune deficiency associated with HIV infection. These diseases are not isolated only to different infections of the skin and underlying tissue but may involve non-infectious disease processes that have a tendency to arise in HIV-positive patients.
The first skin rash in HIV is often in the early stages at the time of seroconversion which is after the “window period”. This is anywhere between 2 to 6 weeks after infection and the patient also reports mild ‘flu-like’ symptoms at the time. Read more on first signs of HIV.
Skin symptoms seen with HIV include :
- Xeroderma – excessive dryness of the skin.
- Pruritus – generalized itching of the skin.
- Drug allergies with itchy skin rash.
Common skin diseases frequently seen in HIV infection or exacerbated in HIV includes :
- Seborrhoeic dermatitis
Skin Infections and Rashes in HIV/AIDS
Dermatomycosis or dermatophytosis is a common skin infection seen in HIV patients and is caused by fungi. While a number of molds or yeasts may be responsible, Malassezia furfur (Pitysporum ovale) is one of the more prevalent fungi. Distribution may be anywhere on the body but the hands, legs, face and chest are more commonly affected. It may also be responsible for folliculitis and secondary infections in seborrheic dermatitis.
Impetigo is an infection of the skin primarily caused by the bacteria Staphylococcus aureus or Streptococcus pyogenes after a break in the skin or with micro-tears formed during scratching. Apart from impaired immunity in HIV infection, the likelihood of developing impetigo is further exacerbated by xeroderma (excessive dryness of skin) in HIV.
Impetigo (Picture from Dermatology Atlas, Courtesy Samuel Freire da Silva M.D.)
A viral infection caused by the Herpes simplex virus (HSV-1 or HSV-2) and has a tendency to affect the mouth or genitals. Also known as cold sores (herpes labialis) or genital herpes, it can also affect other areas, most notably the perianal region (around the anus). With HIV infection, it may spread to the anus and rectum or occur within the oral cavity (mucocutaneous herpes). Chronic infections may be responsible for ulcers in the affected area.
Cold sore/Herpes labialis (Picture from Wikipedia Commons)
Varicella zoster is a virus that causes chickenpox but reactivation later in life results in herpes zoster (shingles). Chickenpox is a common childhood infection but immunization or contracting the disease early in life offers immunity against infection. In the backdrop of HIV infection however, chickenpox and shingles may be frequently seen in adults and the extremely contagious nature of chickenpox often leads to outbreaks.
Chickenpox blister (Picture from Wikipedia Commons)
Human papillomavirus (HPV)
The various different strains of human papillomavirus (HPV) can cause warts in any area. In HIV infection, extensive anogenital warts are persistent and patients may commonly report warts on other areas of the body as well, especially the fingers.
Scabies arises from an allergic reaction to the mite Sarcoptes scabiei which burrows into the skin. The mite eggs and feces are also irritants despite eradicating the mite. The hands and feet, areas between the fingers and toes, abdominal area and buttocks are typically affected. With HIV infection, scabies may also affect the face and neck. HIV-associated scabies tends to present with thick yellow lesions (Norway scabies).
Norwegian scabies (Picture from Dermatology Atlas, Courtesy Samuel Freire da Silva M.D.)
Syphilis is a sexually transmitted infection caused by the bacteria, Treponema pallidum, which presents with painless sores (chancre) on the genitals, rectum or mouth (primary syphilis). Secondary syphilis may cause a rash on the palms and soles.
Chancre : Primary Syphilis (Picture from Wikipedia Commons)
Secondary Syphilis (Picture from Wikipedia Commons)
Kaposi’s sacroma (KS) is a type of skin cancer caused by human herpesvirus type-8 (HHV8) which presents as a red, purple, blue or dark brown rash. It is very rare in in the general population but has become common with the rising incidence of HIV infection. Kaposi’s sarcoma is an AIDS-defining disease.
Kaposi Sarcoma (Picture from Dermatology Atlas, Courtesy Samuel Freire da Silva M.D.)
Molluscum contagiosum is a viral skin infection that causes small raised lesions (papules) particularly on the face, neck, scalp and genitals. The flesh-colored ‘bumps’ typically have a small indentation on the top and can vary from 2 to 5 millimeters in diameter. Some can grow to a very large size.
Molluscum Contagiosum (Picture from Dermatology Atlas, Courtesy Samuel Freire da Silva M.D.)