IM 6.

6 DESCRIBE AND
DISCUSS THE PATHOGENESIS
AND CLINICAL FEATURES OF
COMMON HIV RELATED SKIN
& ORAL LESIONS
CUTANEOUS MAIFESTATIONS OF HIV
• HIV-associated dermatoses are very common.
• Skin disease can be uniquely associated with HIV disease, but more
often represents common disorders, which may be more severe and
recalcitrant to treatment.
• Recognition of characteristic eruptions can facilitate early diagnosis of
HIV. A broad variety of neoplastic, infectious and non-infectious
diseases can manifest in the skin and may alert the clinician to decline
of the immune system.
• Skin disorders are commonly encountered in HIV-infected patients,
and they may be the first manifestation of HIV disease.
• Up to 90% of HIV-infected persons suffer from skin diseases during
their course of illness.
• The spectrum of skin disorders depends on:
• immunologic stage, as reflected by CD4 count
• concurrent use of HAART
• pattern of endemic infections
Pathogenesis
• HIV is not eliminated after primary infection.
• Persistent viral replication in lymphoid organs chronic stimulation of
immune system

• Inappropriate immune activation (immune -dysregulation).

• Progressive exhaustion of the immune response.

• Predisposed to certain infections (bacterial, fungal, mycobacterial, viral),

inflammatory disorders and neoplasms.
HIV related Dermatoses:
• Broadly classified into:
• Infectious manifestations:
• Primary HIV infection
• Infections and Infestations
• Noninfectious manifestations:
• Inflammatory disorders
• Neoplasm's
• Drug eruptions
• Miscellaneous
Clinical Approach to Physical Findings
• The approach to diagnosis of skin lesions includes the assessment of
location, extent, primary lesions, and secondary changes.
• Categories of discrete skin lesions
Papules and plaques are
• Localized skin findings defined as elevated,
1. Papules and Nodules circumscribed skin lesions
2. Plaques involving the epidermis and
3. Vesicles and Bullae dermis, which are less than 1
4. Exanthem± enanthem cm and greater than 1 cm in
diameter, respectively.
• Generalized skin findings
Nodules involve deeper
1. Exanthem± enanthem tissues and are greater than
2. Erythema with desquamation 2 cm in size
3. Papules, plaques
4. Erythema with scaling
Localized skin findings
• Can be generalized in immunosuppressed patients
• Papules and Nodules
• Molluscum Ecthyma
• Furuncle/carbuncle
• Bacillary angiomatosis
• Verruca vulgaris
• Condylomata
• Prurigo nodularis
• Non-melanoma skin cancer: SCC
• BCC
• Kaposi sarcoma
 Molluscum Ecthyma / Contagiosum

• Clinical findings
• 2–3-mm skin-colored
umbilicated papules Eroded,
ulcerated papules with
overlying crust

• Poxvirus family
 Furuncle/carbuncle
• Inflammatory papules and
nodules, tender
Bacillary angiomatosis
• Friable, red, purple, or flesh-
colored papules and nodules
• Bartonella infection in
immunocompromised patients
Verruca vulgaris
• Verruciform hyperkeratotic
papules
• Verruca vulgaris is the
common wart. Verrucae
vulgaris are common warts,
which are caused by infection
with human papillomavirus.
Condylomata
• Skin-colored often pedunculated
verruciform papules
• Condylomata acuminata refers
to anogenital warts caused by
human papillomavirus (HPV).
The most common strains of
HPV that cause anogenital warts
are 6 and 11. HPV is a double-
stranded DNA virus primarily
spread through sexual contact.
Prurigo nodularis
• Excoriated, often
hyperkeratotic papules and
nodules
Non-melanoma skin cancer: SCC & BCC
• Erythematous papules with
variable hyperkeratosis,
crusting, and ulceration
• Non-melanoma skin cancer
is a common type of cancer
that starts in the top layer
of skin.

Squamous. Cell carcinoma (A and D) Basal Cell

Carcinoma (B and C). Courtesy from Skin Cancer Guide
CA.
Infectious manifestations
• ACUTE HIV EXANTHEM
• Maculo-papular rash
• 2- 6 wks after infection
• 50 -70% acute symptoms
• 25% have severe symptoms