Dermatology, Venereology and Leprosy
Skin Manifestations of HIV
HIV skin disease for MBBS and NEET-PG: seroconversion rash, seborrhoeic dermatitis, molluscum, Kaposi sarcoma, atypical infections and antiretroviral effects, mapped to NMC codes DR11.
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Skin Manifestations of HIV
HIV skin disease for MBBS and NEET-PG: seroconversion rash, seborrhoeic dermatitis, molluscum, Kaposi sarcoma, atypical infections and antiretroviral effects, mapped to NMC codes DR11.
HIV infection produces a wide range of cutaneous disease that often heralds or tracks immunosuppression. This chapter covers the seroconversion rash, the markers such as seborrhoeic dermatitis and molluscum, the AIDS-defining Kaposi sarcoma, the atypical presentations of common infections, drug reactions and the effect of antiretroviral therapy.
High-yield: Skin Manifestations of HIV
- The skin is often the first system to signal HIV infection, and cutaneous disease becomes more frequent and severe as immunity falls.
- Acute HIV seroconversion can present with a non-specific maculopapular rash alongside fever, sore throat and lymphadenopathy.
- Extensive or atypical seborrhoeic dermatitis is one of the commonest early skin markers of HIV.
- Recurrent, severe or chronic herpes simplex and disseminated herpes zoster point to significant immunosuppression.
- Widespread or giant molluscum contagiosum in an adult should prompt HIV testing.
- Oral candidiasis and oral hairy leukoplakia are important mucosal markers of advancing disease.
- Kaposi sarcoma, caused by human herpesvirus 8, produces violaceous patches, plaques and nodules and is an AIDS-defining malignancy.
- Eosinophilic folliculitis presents as intensely itchy follicular papules and is characteristic of advanced HIV disease.
- Common infections such as scabies may present atypically, for example as crusted scabies, in advanced immunosuppression.
- Drug reactions are more frequent in HIV, and cotrimoxazole and antiretrovirals are common culprits.
- The severity and range of skin disease broadly track the CD4 count, so certain conditions suggest a particular level of immunity.
- Immune reconstitution inflammatory syndrome can unmask or worsen skin infections shortly after antiretroviral therapy is started.
- Antiretroviral therapy improves most HIV-associated skin disease as immunity recovers.
- Because many skin conditions overlap with those in immunocompetent people, an atypical, severe or recurrent presentation is the clue to underlying HIV.
Skin clues to HIV
- **Early markers:** Seroconversion rash, extensive seborrhoeic dermatitis, recurrent herpes.
- **Advancing disease:** Giant molluscum, oral candidiasis, oral hairy leukoplakia, eosinophilic folliculitis.
- **AIDS-defining:** Kaposi sarcoma (HHV-8), violaceous plaques and nodules.
- **On treatment:** Drug reactions, immune reconstitution flares; overall improvement with ART.
NMC competencies in this chapter
- **DR11.1:** Aetiology, pathogenesis and clinical features of the skin in HIV
- **DR11.2:** Identifying and distinguishing the dermatological manifestations of HIV
- **DR11.3:** Indications and pharmacology of drugs used in HIV-related skin disease
Frequently Asked Questions
Why is the skin important in HIV?
Cutaneous disease is common in HIV and is often the first clue to infection. The type and severity of skin conditions broadly track the level of immunosuppression.
Which skin findings should prompt HIV testing?
Extensive seborrhoeic dermatitis, recurrent or severe herpes, widespread or giant molluscum, oral candidiasis or hairy leukoplakia, and Kaposi sarcoma are among the findings that warrant testing.
What is Kaposi sarcoma?
An AIDS-defining vascular tumour caused by human herpesvirus 8, presenting as violaceous patches, plaques and nodules on the skin and mucosa.
How does antiretroviral therapy affect skin disease?
It generally improves HIV-associated skin conditions as immunity recovers, though an immune reconstitution inflammatory syndrome can temporarily unmask or worsen infections soon after treatment starts.
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