The skin is an organ and not just any organ. It is also the most visible and the largest of the human body. About 90% of people who have HIV will develop skin problems at some point or another during their illness. Indeed, the list of most common skin problems associated with HIV is so long that it would take ages to list them all. Furthermore, the list is forever changing as new treatment options are developed. A lot of the skin problems are caused by opportunistic infections, which is now generally avoided because HIV patients have a better supported immune system.
HIV Disease Progression
Generally, as HIV progresses, the number of skin problems also progress. This is a normal consequence of the decreasing amount of CD4. On the other hand, however, it is important to realize that people without HIV also develop numerous skin problems. At the same time, one of the first symptoms of a HIV infection is often a skin problem, in particular a strange rash that can cover nearly all of the body.
HIV and Skin Problems
Firstly, a lot of HIV patients will suffer from generalized dermatitis. This means they have various skin rashes that can be linked to specific illnesses. These rashes include:
• Xerosis, which nearly one quarter of HIV individuals will develop. This is skin dryness, particularly on the extremities of the body. Moisturisers with steroids and urea are generally effective.
• Atopic dermatitis, which is a type of chronic inflammation. It presents as itchy skin sores that are often scaly and red. Around half of all HIV patients develop this and will require topical steroids for treatment.
• Prurigo nodularis, which shows as lumps that are often very itchy and scab-like in appearance. This tends to happen only in those who immune system is significantly compromised and are approaching full-blown AIDS. Antiretroviral drugs and topical steroids are generally prescribed.
• Eosinophillic folliculitis, which are incredibly itchy bumps on the hair follicles. This is something seen in the later stages of HIV and tends to cluster on the head or other upper body parts. Generally, treatment includes topical steroids, antiretroviral drugs and antihistamines.
Other skin problems are often caused by fungal, bacterial, parasitic and viral infections. These include:
• Herpes zoster, which is part of the chickenpox virus. It often causes shingles and requires antiviral drugs.
• Molluscum contagiosum, which is hugely contagious and generally requires multiple treatments. It presents as flesh-coloured skin blisters and these generally have to be frozen or removed by laser.
• Oral hairy leukoplakia, which shows as lesions on the tongue. It tends to require some antiretroviral treatment.
• Thrush, which is a common fungal infection that can affect the tongue and genitals. Antifungal medication is usually highly effective, as are creams.
Then, HIV patients commonly develop skin lesions. Kaposi scarcoma is the most common lesion, which is actually a form of skin cancer. It affects the blood vessels and/or the lymph nodes and presents itself as very dark lesions. They are often purple or brown in color. It is a form of cancer and will generally spread to the liver, lungs and digestive tract. Once Kaposi scarcoma presents, most patients will receive a full AIDS diagnosis, moving away from HIV. Indeed, it is very common for AIDS produce skin lesions to occur, and it is not always clear what comes first: AIDS or Kaposi scarcoma. Treatment includes chemotherapy and radiotherapy, as well as surgery where possible. There is also some evidence to suggest retroviral drugs can help.
HIV patients will almost always experience at least some of the conditions described above, if not all. A good physician will discuss all of this with their patients, as well as explaining what they can do in order to prevent it. Furthermore, physicians will also teach patients how to recognize developments of skin problems so that they can seek treatment as soon as possible. However, it always remain best to prevent HIV infection than to treat it!