Part A: Module A8

1

Skin Lesions

• Part A Module A8
• Session 8

2
Skin lesions

• 80-100 of persons livng with HIV/AIDS develop
  dermatological conditions
• May be very disabling, disfiguring and even
  life-threatening

3
Etiologies of Skin Lesions

• Bacterial infection Streptococcus aureus,
  streptococcus species, Treponema pallidum,
• Bartonella species
•  
• Mycobacterial infection M. tuberculosis, M.
  Avium complex
• Viral infection Herpes simplex and zoster
  virus, molluscum contagiosum, condylomata
  accuminata
• Infestations Scabies
• Fungal infection seborrheic dermatitis, tinea
  corporis, pityriasis versicolor,
  Cryptococcus neoformans, Histoplasma
  capsulatum, Candida species
•  

4
Clues from presentation

• Warm, inflamed, painful and/or fluctuant---a
  bacterial infection
• Discolored skin patches----a fungal infection or
  Kaposis sarcoma
• Localized eruptions or localized pimple-like
  swellings--- a viral infection
•  
• Prurigo/urticaria, macular, maculopapular or
  scaly lesions-- classified as other skin
  conditions, including drug eruptions, seborrhea,
  psoriasis, and scabies

5
Possible Differentials Skin Conditions

• Bacterial Skin abscess or pyomyositis
• Furunculosis or folliculitis
• Hydradenitis suppurativa
• Impetigo
• Kaposis Sarcoma
• Fungal Tinea, Candidiasis
• Viral Herpes Simplex Condylomata
  acuminata
• Herpes zoster
• Molluscum contagiosum

6
Skin Conditions, continued.

• Prurigo and other skin conditions
• Drug eruptions
• HIV-associated rash
• itchy generalized maculo-papular rash
• Seborrheic dermatitis or generalized erythroderma
• Psoriasis
• Scabies
• Other dermatoses

7
Prurigo Nodularis
8
Prurigo
9
Psoriasis
10
Fixed drug eruption on cotrimoxazole
11
Stevens-Johnson in patient on thiocetazone
severe mucositis lesions
12
Seborrheic Dermatitis
13
Non-Hodgkins Lymphoma

• Fever, night sweats, unexplained weight loss
• Lymphadenopathy, splenomegaly, pancytopenia,
  bowel obstruction, ascites, cranial nerve
  lesions, spinal cord suppression, nerve root
  lesions, cutaneous, testicular and lung mass
  lesions
• Prognosis poor when CD4 is lt100
• Treatment is chemotherapy

14
Central Nervous System Lymphoma

• End-stage complication (CD4lt100)
• IF no biopsy available, failure of trial of
  treatment for toxo considered diagnostic of CNS
  lymphoma
• Irradiation is palliative, no cytotoxic therapy
• Survival after diagnosis limited to a few months

15
Cryptococcosis
16
Herpes Zoster-- Shingles