Drug Eruptions in HIV Patients with Darker Skin

00:01 We are now going to talk about drug eruptions in HIV patients.

00:05 Drug eruptions are 100 times more prevalent in individuals with HIV for a number of reasons.

00:14 75% of drug eruptions are due to antibiotics, particularly Bactrim. Patients with HIV tend to be on multiple pharmacotherapy because of the different conditions that they may experience. It tends to increase with declining CD4 count. Now let's have a look at one of the drug eruptions that are common in HIV.

00:39 Maculopapular rash, it's most common type.

00:42 You can see macules and papules that are erythematous in white skin.

00:46 However, in black skin you see dusky redness and sometimes like not redness on the skin. This occurs typically from one week to three weeks after first exposure.

00:59 It usually resolves with drug discontinuation.

01:03 As I mentioned, erythema may be so subtle in the dark skin.

01:08 Stevens-johnson syndrome and toxic epidermal necrolysis are some of the severe drug reactions that we can get in patients with HIV, even sometimes in patients who don't have HIV.

01:19 It typically must manifest 4 to 6 weeks after initiating a particular medication. And some of the drugs that have been implicated in Stevens-Johnson syndrome or toxic epidermal necrolysis include anti-tb drugs, anticonvulsants, nonsteroidal anti-inflammatory drugs, antibiotics are and other may be analgesics.

01:46 Stevens-johnson syndrome tends to be more extensive, involving the mucosa, the skin, and sometimes systemic organs, so the liver, the kidneys, and the lungs may be involved in patients with extensive or severe drug reactions. Here you can appreciate involvement of the palms and soles and the peeling of the skin.

02:12 This is a patient with toxic epidermal necrolysis and you can see the extensive peeling of the skin. I often say to students, it's like taking a pitch, put it in hot water and how the skin peels. That's how TN looks like.

02:30 You can see the involvement of the mucosa as well as the conjunctiva.

02:35 So in some patients you also get involvement of the genital area.