It is for educational purpose only HIV 2.ppt

It is for educational purpose only

1. SKIN MANIFESTATIONS
OF HIV/AIDS
SUMMERY

2. INTRODUCTION
•Up to 92% of HIV/AIDS patient will have one
or more skin disorders during the course their
illness.
•Recognizing HIV-related skin changes may lead
to the diagnosis of HIV infection in the early
stages, which allows initiation of appropriate
antiretroviral therapy

3. INTRODUCTION
•Dermatological manifestations are seen
at every stage of HIV/AIDS
•Some of the conditions are unique and
virtually pathognomonic for HIV disease
like bacillary angiomatosisand oral hairy
leukoplakia.

4. HIV replication cycle and sites of drug activity
Capsid
proteins
and viral
RNA
CD4
Receptor
Viral RNA
New HIV
particles
Protease
Attachment Uncoating Reverse
Transcription
IntegrationTranscription
Translation
Reverse
Transcriptase
Unintegrated
double stranded
Viral DNA
Integrated
viral DNA
Viral
mRNA
Integrase
gag-pol
polyprotein
1 2 3 4
5
6
Assembly and
Release
Protease Inhibitors
Indinavir (Crixivan)
Ritonavir (Norvir)
Saquinavir (Fortovase)
Nelfinavir (Viracept)
Amprenavir (Angenerase)
Lopinavir/ritonavir (Kaletra)
Atazanavir (Reyataz)
NRTIs
AZT (Zidovudine-Retrovir)
ddI (Didanosine-Videx)
ddC (Zalcitabine-Hivid)
d4T (Stavudine-Zerit)
3TC (Lamivudine-Epivir)
ABC(Abacavir-Ziagen)
FTC (Emtricitabine, Emtriva)
NNRTIs
Efavirenz (Sustiva)
Delavirdine (Rescriptor)
Nevirapine (Viramune)
Nucleus
Cellular DNA
CCR5
or
CXCR4
co-receptor
HIV Virions
nRTI
Tenofovir DF
(Viread)
T-20
(Enfuvirtide,
Fuzeon)

5. Acute Retroviral Syndrome
•80 percent of cases
•several weeks before seroconversion
•IP 3 to 6 weeks
•Constitutional symptoms are followed by
exanthematous rash.
•The more severe the ARS, the worse the
prognosis of AIDS will be.
•Some recommend giving HAART for 6
months to 2 years.

7. Seborrhoeic dermatitis
•The most common dermatosis
•The eruption, characterized by widespread
inflammatory and hyperkeratotic lesions in
seborrhoeic areas, may progress to
erythroderma.
•It is usually resistant to treatment

10. Xerosis
•Generalized dry skin syndrome is more
frequently observed in patients with HIV
infection.
•It is often accompanied by severe itching.

15. Pruritic papular eruption (PPE)
•Common and relatively specific manifestation,
60% have advanced immunosuppression
•Small, itchy, red or skin-colored papules on the
head, the neck, and the upper part of the trunk
•The cause is not known.
•Emollients, steroid and antihistamines give
temporary relief

21. Eosinophilic folliculitis
•An idiopathic, highly pruritic, papulopustular
eruption of sterile pustules around hair follicles
involving the face, the neck, the trunk, and the
extremities and occurring in advanced
immunodeficiency.
•May be the extreme of PPE.
•Resistant to all forms of treatment. Steroid may
help.

24. Bacterial infections
•Impetigo and folliculitis may be recurrent
and persistent in HIV disease, particularly
in children
•Disseminated furunculosis, gingivitis,
gangrenous stomatitis, and abscess
formation frequently occur

28. Bacillary Angiomatosis
•Known to occur exclusively in HIV infection
•Caused by Bartonela quintana
•It presents as fleshy, friable, protuberant papules-
to-nodules that tend to bleed very easily.
•Confuses with Kapos’s sarcoma and other vascular
tumors.
•Treatment consists of prolonged use of antibiotics.

31. Fungal Infections
•Dermatophytosis has the same
frequency as the general population,
may be more extensive and resistant
to treatment.

32. Fungal Infections
•Recurrent and severe oropharyngeal
candidiasis, usually extending to the
esophagus and/or trachea is the
presenting symptom and indicates
immunosupression

33. Fungal Infections
•Deep and rare fungal infections like
cryptococcosis, coccidiomycosis, and
histoplasmosis affecting the systemic organs
and the skin are unique features of advanced
AIDS.

36. Oral Hairy Leukoplakia
•Very specific manifestation of HIV infection
presenting as filiform white papules or plaques
forming reticulate pattern on the inferiolateral
border of the mouth.
•It is due to Epstein-Bar virus infection.
•May be the initial sign of progressive
immunosuppression

40. Warts
•Lesions may be extensive and resistant to
therapy. warts usually look like those seen in
nonimmunosuppressed patients, but are more
extensive.
•Flat warts on adult face are typical features of
HIV infection.

41. Warts
•Condyloma acuminata are of special
significance in persons with HIV infection.
•They are very difficult to eradicate.
•Cervical dysplasia and carcinoma are more
frequent and invasive cervical ca is a case
defining illness.

42. Warts
•Condyloma acuminata are of special
significance in persons with HIV infection.
•They are very difficult to eradicate.
•Cervical dysplasia and carcinoma are more
frequent and invasive cervical ca is a case
defining illness.

45. Herpes Simplex Virus
Infection
•Chronic persistent infection with herpes
simplex virus (HSV) is AIDS defining illness.
•Ulceration and necrosis is the usual finding
with no prior history of blisters.
•Generalized forms with meningitis may occur
in advanced immunosupression.
•Prolonged treatment with intravenous
acyclovir is needed for extensive cases.

50. Herpes Zoster
•Commonly seen early in the course of HIV
infection, particularly in healthy-appearing
individuals
•May be particularly bullous, hemorrhagic,
necrotic, and painful
•Recurrences and multidermatomal
involvement is common
•Treatment need s systemic acyclovir

55. Chicken pox

56. Molluscum Contagiosum
•Occurrence of MC on the face of an adult is an
indication to screen for HIV
•They often number greater than 100 and may
involve the face, trunk, and groin
•Spontaneous healing is rare
•No hematogenous spread

60. Kaposi’s Sarcoma
•The first reported malignancy in association
with HIV infection
•Appears as red-to-brown flat macules in any
site, mainly above the trunk
•Prognosis is poor and kills the patient unless
HAART is instituted immediately

69. Scabies
•Frequency the same
•Norwegian (crusted) scabies, which is
characterized by wide spread
hyperkeratotic plaque occurs on palms and
soles.
•Prolonged treatment with repeated course
of scabicides is needed

73. Hypersensitivity Reactions
•The immune dysregulation associated with
AIDS has made these patients to react
abnormally for any exogenous stimuli like
arthropod bite, drugs, and UV radiation

79. Hair and Nail Disorders
•Diffuse alopecia or alopecia areata
•Elongation of the eyelashes and softening and
straightening of the scalp hair
•Beau’s lines
•Blue nails
•Proximal subungal onychomycosis