Part A: Module A8

Session 8

Skin Lesions

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Skin lesions

80-100% of persons livng with HIV/AIDS

develop dermatological conditions

May be very disabling, disfiguring and even

life-threatening

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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  

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Clues from presentation

Warm, inflamed, painful and/or fluctuant---a bacterial infection

Discolored skin patches----a fungal infection or

Kaposi’s 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

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Possible Differentials: Skin Conditions

Bacterial Skin abscess or pyomyositisFurunculosis or folliculitisHydradenitis suppurativaImpetigo

Kaposi’s Sarcoma

Fungal Tinea, Candidiasis

Viral Herpes Simplex Condylomata

acuminataHerpes zosterMolluscum contagiosum

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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

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Prurigo Nodularis

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Prurigo

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Psoriasis

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Fixed drug eruption on cotrimoxazole

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Stevens-Johnson in patient on thiocetazone: severe mucositis lesions

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Seborrheic Dermatitis

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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 <100

Treatment is chemotherapy

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Central Nervous System Lymphoma

End-stage complication (CD4<100)

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

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Cryptococcosis

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Herpes Zoster--Shingles