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Giornale Italiano di Dermatologia e Venereologia 2006 June;141(3):267-77


language: English

Human immunodeficiency virus and dermatology. A focus on special diseases and a review of the literature

Beltraminelli H., Itin P. H.

Dermatology Unit, University Hospital, Basel, Switzerland


Cutaneous disorders can be seen in any stage of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), including a wide spectrum of diseases which, owing to the rapid development of anti-HIV drugs, have changed relevance during the history of HIV infection. With the advent of highly active antiretroviral therapy, many skin disorders have improved or disappeared completely, whereas others may even worsen as the patient's immune status begins to recover, a phenomenon known as the immune reconstitution syndrome. Disorders such as Kaposi's sarcoma and oral hairy leukoplakia are typical but not specific for HIV infection. When recognized, HIV infection needs to be determined serologically. Seborrhoic dermatitis or atypic herpes simplex are commonly associated with HIV infection but they can often be present without the infection. Dermatological manifestations such as generalized skin rash are a presenting feature in 40% of cases of acute HIV infection. In 10% of HIV patients, stomatologic findings are the first clinical sign of the disease and can help to establish a diagnosis of HIV infection. Most cutaneous disorders in the setting of AIDS share common features: an unusual presentation with atypical localization, widespread eruption, sudden exacerbations, resistance to treatment and often a chronic course; some reflect the patient's underlying immune status; manifestations of disseminated and extensive disease typically co-present with laboratory findings of lower CD4+ cell count and/or high viral load. Some HIV-associated systemic fungal infections (without skin correlations) and some adverse drug reactions (with evident skin manifestations) may be life-threatening. Moreover, many drugs can produce several adverse effects and possible interactions. Hence, in the setting of HIV, a high index of suspicion is a vital for establishing early diagnosis and instituting prompt, effective treatment.

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