Highlights
- Skin conditions are prevalent in 90% of individuals living with HIV, affecting overall health.
- Early recognition and management of dermatologic symptoms are crucial for improved patient outcomes.
Summary and Overview
Human immunodeficiency virus (HIV) infection causes progressive immune impairment, making individuals vulnerable to a wide range of skin disorders. Approximately 90% of people with HIV experience skin manifestations, which range from mild rashes and drug reactions to severe opportunistic infections, inflammatory dermatoses, and malignancies like Kaposi sarcoma. These symptoms often reflect immune status and disease progression.
Antiretroviral therapy (ART) controls HIV but can cause skin reactions such as hypersensitivity rashes and immune reconstitution inflammatory syndrome (IRIS). Early recognition and management of skin conditions are vital for diagnosis, treatment, and improving outcomes. Visible skin lesions also contribute to stigma and psychological distress, affecting healthcare engagement. This article summarizes HIV-related dermatologic manifestations, their immunopathogenesis, effects of ART, psychosocial impact, and care challenges.
Common Skin Symptoms and Conditions in HIV
Skin symptoms affect nearly all HIV patients during their illness, ranging from mild rashes to severe infections and malignancies. The HIV-associated rash is common, often as flat, red areas with small bumps, either due to the virus or drug reactions. Drug hypersensitivity, including severe reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis, occurs more frequently in HIV.
Viral infections such as shingles and molluscum contagiosum are common, with lesions often larger and more persistent in HIV. Fungal infections (e.g., candidiasis, tinea), bacterial infections including MRSA, and inflammatory dermatoses like seborrheic dermatitis and psoriasis occur frequently and may be more severe. Kaposi sarcoma is a notable HIV-associated malignancy, particularly in advanced disease.
Skin symptoms often correlate with immune suppression level and improve with effective ART. Prompt treatment includes targeted antimicrobial therapies and supportive skin care. Psychosocial impacts from visible lesions underscore the need for compassionate care and education.
Immunopathogenesis and ART-Related Skin Effects
HIV depletes CD4+ T cells and antigen-presenting cells in the skin, weakening immune defenses and allowing opportunistic infections and malignancies. Xerosis (dry skin) is common and linked to multiple factors including impaired skin function and reduced neuropeptides. Kaposi sarcoma cells exhibit immune evasion mechanisms facilitating tumor persistence. ART restores immunity but may trigger IRIS, causing inflammatory skin reactions that can mimic drug eruptions and complicate management.
ART can also cause drug-induced skin reactions ranging from mild rashes to life-threatening conditions. Photosensitivity is observed in some patients, requiring sun protection. Most ART-related skin issues resolve with symptomatic care, but severe cases may require drug modification.
Key Dermatologic Conditions
Molluscum Contagiosum: Presents as clustered, dome-shaped papules that are larger and more resistant in HIV patients.
Kaposi’s Sarcoma: AIDS-defining cancer with violaceous skin and mucosal lesions, declining with ART but still significant.
Eosinophilic Folliculitis: Pruritic papules around hair follicles, often improving with ART.
Papular Pruritic Eruptions: Intense itchy papules signaling advanced immunosuppression.
Seborrheic Dermatitis and Psoriasis: Common inflammatory conditions that may worsen with immune decline.
Diagnosis and Management
Diagnosis involves clinical evaluation supported by histopathology when needed. Skin symptoms can indicate immune status and guide HIV disease staging. Treatment centers on ART to restore immunity and control viral replication. Specific skin conditions are managed with antivirals, antifungals, antibiotics, or immunomodulators as appropriate. Drug reactions require prompt identification and may necessitate changing medications. Supportive care includes emollients for xerosis and sun protection for photosensitivity. Multidisciplinary care and patient education improve treatment adherence and outcomes.
Psychosocial Impact and Barriers to Care
Visible skin conditions in HIV cause stigma, social isolation, and psychological distress, negatively affecting self-esteem and healthcare engagement. Stigma, often fueled by misinformation and cultural beliefs, leads to delays in testing and treatment. Children and adolescents with HIV face additional challenges due to disfiguring lesions and social exclusion. Addressing psychosocial aspects through education, clear communication, and multidisciplinary support is essential to improve quality of life and care access.
When to Seek Medical Attention and Prognosis
Patients should seek prompt medical evaluation for unusual or persistent skin symptoms, as these may indicate immunosuppression or opportunistic infections. Early diagnosis and ART initiation are crucial to improve prognosis. While many skin conditions improve with treatment and immune restoration, some persist or worsen, requiring ongoing management. Comprehensive care and patient-centered approaches enhance outcomes and quality of life for people living with HIV.
The content is provided by Avery Redwood, Scopewires
