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.
Dry Skin and Itching
These skin diseases are not only different infections of the skin and the underlying tissue. It may involve non-infectious skin conditions that have a tendency to arise in HIV positive people. The first skin rash in HIV is often seem 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.
Common skin symptoms seen with HIV include :
- Xeroderma which is excessive dryness of the skin.
- Pruritus which is generalized itching of the skin.
- Drug allergies with itchy skin rash.
For some people living with HIV, these skin symptoms arise early in the disease. Others may be HIV positive for years with little to no skin symptoms. However, skin diseases become more common and more severe as immune function declines. Similarly other diseases may also be more likely with declining immune function, such as HIV cancers of which most are not dependent on the presence of HIV infection to occur.
Skin Infections and Rashes in HIV/AIDS
Common skin diseases frequently seen in HIV infection or exacerbated in HIV includes :
It is important to note that these are common skin diseases, along with some others discussed below.These conditions are usually not related to HIV infection. Most people who have these skin infections are not HIV positive. However, HIV infection and AIDS increases the risk of these skin conditions developing and may worsen it if it was already present (pre-existing skin conditions).
Dermatomycosis or dermatophytosis is a common fungal skin infection that can affect any person but tends to be more frequently seen with HI. While a number of dermatophytes 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.
Dermatomycosis, Fungal Rash (Picture from Dermatology Atlas)
Impetigo is a bacterial 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. If the infection extends deeper into the tissue under the skin then it may result in cellulitis.
Impetigo (Picture from Dermatology Atlas)
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 Wikimedia 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 Wikimedia 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.
Human Papilloma Virus (HPV) Warts (Picture from Dermatology Atlas)
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)
Syphilis is a sexually transmitted infection caused by the bacterium, Treponema pallidum, which presents with painless sores (chancre) on the genitals, rectum or mouth (primary syphilis). It may or may not be transmitted at the same time as the human immundeficiency virus (HIV). Apart from the sores seen in primary syphilis, there are other skin lesions in secondary syphilis such as a rash on the palms and soles.
Chancre : Primary Syphilis (Picture from Wikimedia Commons)
Secondary Syphilis (Picture from Wikimedia Commons)
Kaposi sarcoma (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 sarcoma is an AIDS-defining disease meaning that is presence is usually considered as a sign of declining immunity in a person living with HIV infection.
Kaposi Sarcoma (Picture from Dermatology Atlas)
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. These bumps are usually painless. The infection can spread to surrounding skin if the bump is injured, usually as a result of scratching.
Molluscum Contagiosum (Picture from Dermatology Atlas)
- Cutaneous Manifestations of HIV. Medscape
- Dermatology Atlas Brazil. atlasdermatologico.com.br