Cutaneous Lesions Associated
The acquired immune deficiency syndrome (AIDS) is caused by human immune deficiency virus (HIV) infection,
damaging the cell mediated immune system.
Skin is the most commonly affected organ in HIV infection. Cutaneous lesions in HIV positive patients serve as a marker of HIV infection and also indicates the stage of the disease.
Opportunistic infection patterns are different in different parts of the world and change as people migrate.
'Highly active antiretroviral therapy' (HAART) was introduced in 1997. Opportunistic infections in HIV positive patients have decreased since introduction of the therapy. Following therapy there is fall in viral titre and increase in CD4 cells. The cutaneous conditions improve or decline in incidence after the therapy.
Infectious diseases in AIDS
Virus related lesions in AIDS:
Molluscum contagiosum: In HIV- positive patients this lesion presents as persistent umbilicated or verrucous papules, commonly on the head and neck region.
Histopathology reveals cup-shaped lesion containing molluscum bodies.
Giant and warty verrucous mollusca contagiosa are markers of advanced HIV infection.
Herpes Simplex: Usually occurs in perianal, genital and orofacial skin.
In HIV and HSV coinfection the lesions last for more than one month.
Histopathology reveals numerous intranuclear and intracytoplasmic nuclear inclusions.
Extensive ulceration and intraepidermal acantholytic vesicles are noted.
Varicela zoster virus infection: Clues to HIV and VZV coinfection - The lesions usually occur in younger patients. These are more severe lesions and of longer duration.
Human papillomavirus infection:There is a high incidence of common and anogenital wart in HIV positive patients.
Condylomata acuminata may occur in HIV infected homosexual men.
There is risk of dysplasia in perianal condyloma.
Grossly, these lesions may present as smooth sessile plaques to exophytic cauliflower plaques.
Verrucae vulgaris, multiple plantar warts, flat and filiform warts may be noted in HIV infected patients.
Common warts are frequently present on the bearded area of the face in HIV positive patients.
Cytomegalovirus : Almost 90% HIV positive patients develop Cytomegalovirus infection.
Histological examination reveals Cytomegalovirus inclusions in endothelial cells and fibroblasts together with areas of epidermal necrosis.
Oral hairy leukoplakia: Poorly defined projections are noted on the lateral borders of the tongue.
This lesion indicates advanced immunosuppression.
Causative organisms include Epstein-Barr virus, human papillomavirus or candida.
Histological examination reveals some acanthosis and parakeratosis.
Large pale staining cells resembling keratinocytes are present.
- In HIV positive patients, lichen planus (hypertrophic) is widely distributed involving face and extremities.
There is extensive epidermal hyperkeratosis, acanthosis, hypergranulosis and a dense lichenoid inflammatory infiltrate.
- Seborrheic dermatitis is characterized by dermal perivascular acute inflammatory infiltrate and keratinocyte necrosis.
- HIV associated eosinophilic folliculitis is usually noted in the last stage of HIV disease.
There is follicular spongiosis together with infiltration of eosinophils and lymphocytes.
Flame figures and eosinophil degranulation may be noted in the dermis.
- Chronic actinic dermatitis is characterized by psoriasiform epidermal hyperplasia and interphase dermatitis.
Necrotic keratinocytes and eosinophils are present. This lesion may indicate advanced HIV infection.
- Cutaneous drug eruptions may be noted in HIV positive patients taking trimethoprim-sulphamethozole.
These lesions are characterized by vacuolar degeneration of basal layer, dermal inflammation , pigment incontinence and necrotic keratinocytes.
List of bacterial lesions in patients with AIDS:
Mycobacterial infections- (Mycobacteium avium-intracellulare , Mycobacterium Kansasii, Mycobacterium haemophilum, Mycobacterium marinum etc)
List of fungal lesions in patients with AIDS:
Protozoal infection AIDS:
Acanthamebiasis ; Pneumocystis Pneumonia
Arthropod related lesions: Scabies ; Demodicosis ;
The following cutaneous lesions are noted in patients with AIDS: (Dermpath-India)
- Seborrheic dermatitis ;
- Psoriasis vulgaris ;
- Hypertrophic lichen planus ;
- Eosinophilic folliculitis;
- Contact dermatitis ;
- HIV associated photosensitivity;
- Cutaneous drug eruption ;
Neoplasms related to AIDS are as follows:
- Kaposi's Sarcoma: Epidemic (HIV associated) Kaposi's Sarcoma
- Bowen's disease :
- Squamous cell carcinoma :
- Basal cell carcinoma:
Related post: AIDS related malignant tumors
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