Inflammatory Skin Diseases in HIV Patients with Darker Skin

00:01 What about inflammatory skin diseases in HIV patients? How are they how do they present and how are they affected? Let's look at seborrheic dermatitis.

00:11 It's the most common inflammatory dermatosis that presents in patients with HIV AIDS. The incidence is from 32% to about 83%, and the severity of seborrheic dermatitis tends to rise with immunosuppression.

00:27 The involvement is typical.

00:28 The flexural, scalp predominance, as well as involvement of your nasolabial fold and behind the ears.

00:36 This is a young patient with HIV, with classical crusted lesions and wet lesions of seborrheic dermatitis, again involving the seborrheic areas.

00:50 Of course one has to entertain other differentials.

00:53 But when you see sebderm it is quite extensive, you got to offer the patient HIV screening.

01:01 The treatment is similar to immunocompetent patients, but may need longer duration and a more aggressive approach.

01:09 Need to note that viral and bacterial co-infections may need to be addressed as well, as these patients are prone to secondary infection with viral herpes simplex virus, as well as staph and staph infection.

01:25 Now let's talk about papular eruptions in HIV.

01:28 These presenters urticarial papules, excoriations and sometimes with inflammatory pigmentation and prurigo.

01:37 It's associated with CD4 counts that are less than 200.

01:41 And the first example of Papular eruption that we're going to talk about is eosinophilic folliculitis.

01:46 As the term says eosinophilic folliculitis, on histology you see eosinophils around the hair follicle.

01:54 So here you can see this picture of a patient with papules and pustules, intensely pruritic. And you can see by the excoriations that are quite extensive on the face and skin. And it tends to involve the face, the scalp and the upper limbs.

02:12 The second type is the pruritic popular eruption, what we refer to as PPE.

02:18 This is the most prevalent rash among HIV patients, affecting about 11% to 46% of individuals, including children. Once a small, red, pruritic, firm papules and they evolve into hypopigmented, macules and nodules.

02:36 The predilection sites are the exposed skin and as well as the extremities.

02:41 It's important again to note in black patients that most of these conditions will leave residual post-inflammatory hyperpigmentation, which bothers patients, although the active skin lesions have healed.

02:53 So it's important that we pay attention to that as physicians.

02:59 The following table shows the differences between the three popular conditions.

03:03 Have a look at the table and compare the key differences between these three conditions.

03:14 So how do we treat EF and PPE? We use systemic antihistamines and topical steroids.

03:20 Remember it's intensely pruritic.

03:24 Tetracyclines have also been used as they are anti-inflammatory, so they help to reduce inflammation and therefore reduce the clinical lesions.

03:32 Of course, we have to make sure that patients are on full HAART HIV treatment and topical steroids are also used to reduce the inflammation.

03:42 Recurrence tends to occur and is associated with virologic failure. Xerosis is a refers to dry skin, so patients may present with features resembling ichthyosis, the so-called acquired ichthyosis that is associated with a number of conditions, one of them being HIV, sarcoidosis and leprosy.

04:08 So the skin tends to resemble fish scales, as you can see on this picture, the crazy paving.

04:18 The treatment of cirrhosis is using emollients, soap substitutes, or gentle cleansing oils.

04:27 Antihistamines should be started if no response to first-line therapy.