|
The acquired immune deficiency syndrome
(AIDS) is caused by human immune deficiency virus (HIV) infection,
damaging the cell mediated immune system.
Visit:
AIDS related malignant tumors
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. In many developing countries
HAART is still not widely available.
INFECTIONS
Viral:
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 .
Image 1 ;
Image2 ;
Image3
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.
Image1 ;
Image2
.
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.
Image1
;
Image2 ;
Image3
.
Cytomegalovirus: Almost 90% HIV positive patients develop
CMV infection. Histological examination reveals
CMV inclusions in endothelial cells and fibroblasts together with areas of
epidermal necrosis . Image
Link1 (Univ. of Washington) ;
Image Link2 (pathguy.com)
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.
Image 1 ;
Image2
;
Image3
.
NOTE:
Viral, bacterial, fungal and parasitic
infections may occur alone or in combination with each other. In HIV
infected patients, fungal disorders may present as disseminated or localised disorders.
Histoplasmosis
,
Cryptococcosis ,
sporotrichosis and
candidiasis are common in AIDS patients. Staphylococcus aureus is the most
common bacterial pathogen identified in HIV- infected patients. Numerous
non-tuberculous mycobacteria may cause cutaneous lesions in HIV positive
patients. These lesions display a range of histological features ranging
from suppurative to granulomatous inflammmation.
HISTOLOGICAL FEATURES IN INFLAMMATORY
DERMATOSIS IN HIV-POSITIVE PATIENTS:
1. Neutrophils and eosinophils in the inflammatory infiltrate are
increased in number.
2. Plasma cells are present.
3. Apoptotic keratinocyte may be present
4. T-cells negative for CD7 are increased in the inflammatory infiltrate.
5. Increased number of CD30 positive cells appear in the inflammatory
infiltrate.
6. Histological examination of papular eruptions in HIV positive patients
reveal superficial perivascular infiltrate of lymphocytes and some
eosinophils. Dermal fibrosis and features of early necrobiosis are often
present.
NOTE:
- 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.
Bacterial:
Mycobacterial
infections- (Mycobacteium avium-intracellulare
, M. Kansasii, M.
haemophilum, M. marinum etc)
Image1 ;
Image2
Usual infections- (staphyloccocus aureus, staphylococcus pyogenes)
Image1
Image2 ;
Syphilis ;
Image1 ;
Image2 ;
Image3 .
Bacillary angiomatosis:.
Fungal:
Histoplasmosis
;
Cryptococcosis
Image1 ;
Image2 ;
Image3 .
Candidiasis;
Sporotrichosis:;
Penicillium marneffei;
Mucormycosis;
Protozoa:
Acanthamebiasis :
Image1 ;
Image2.
Pneumocystis Pneumonia
:
Image
Arthropod:
Scabies :
Image ;
Demodicosis:
DERMATOSIS
Seborrheic dermatitis ;
Psoriasis vulgaris ;
Hypertrophic lichen planus
DermAtlas ; Eosinophilic folliculitis;
Contact dermatitis ;
HIV associated photosensitivity
Cutaneous drug eruption ;
NEOPLASMS
Kaposi's Sarcoma: EPIDEMIC ( HIV ASSOCIATED )KAPOSI'S SARCOMA
Cutaneous lymphoma :
Bowen's disease :
Squamous cell carcinoma :
Basal cell carcinoma:
Further reading:
Dermatologic Manifestations
of HIV Infection.
Top HIV Med. 2005 Dec-2006 Jan;13(5):149-54.
Oral Manifestations of HIV
Disease.Top
HIV Med. 2005 Dec-2006 Jan;13(5):143-8
|
