1/@HoustonAETC lunch & learns are 🔥!
@MelanieGoebelMD gave a fantastic talk on primary manifestations of skin diseases in PWH (people with HIV)
Let's review rapid-fire style...
#IDFellows #IDTwitter #DermTwitter #MedTwitter @idfellows @MedTweetorials
2/
30YOM with well-controlled HIV and several months of this itchy red rash with silvery scales:
3/What is the most likely diagnosis?
4/Answer: Psoriasis
🔸Overall prevalence in PWH ≈ non-PWH
🔸But PWH have ⬆️ psoriatic arthritis, inverse psoriasis (axilla, intertriginous areas), and severe psoriasis
🔸Tx: ART, topical steroids, systemic treatment (methotrexate)
5/
60YOM with unsheltered homelessness, HIV (CD4=7). He developed several months of this intensely pruritic skin eruption involving the "V" area of his chest, dorsal forearms, and face. He is not on any medications.
6/What is the most likely diagnosis?
7/Answer: Photodermatitis (darkening of skin exposed to sun)
🔸5% of PWH, CD4 <200, 6x more likely in AA
🔸HIV is photosensitizing➡️dysfunctional free radical scavenging pathways
🔸⬆️risk w TMP-SMX, NSAIDS, some ART
🔸Tx: ART, sun protection, topical steroids
8/
26YOM with HIV (CD4=22) developed these nodular itchy lesions on his face, trunk, and limbs over 2 months:
9/What is the most likely diagnosis?
10/Answer: Prurigo nodularis
🔸Associated with other systemic diseases👉DM, CKD, CVD, HCV
🔸⬆️ frequency if CD4 < 50
🔸Pathogenesis unknown, ⁉️ Th2 cytokines
🔸Tx: ART, topical steroids, antihistamines, emollients, phototherapy, thalidomide (refractory PN)
11/
20YO developed severe generalized itching and multiple discrete papules over her face, trunk, arms, and the dorsum of her hands over 4 months. HIV test was positive.
12/What is the most likely diagnosis?
13/Answer: Papular pruritic eruption
🔸Pruritic, skin-colored papules, +/- post-inflammatory hyperpigmentation
🔸Common in sub-Saharan Africa, tropics
🔸Pathophys: bug bites hypersensitivity
🔸⬇ CD4 ⬆️severity of eruption
🔸Tx: ART, antihistamines, topical steroids
14/
22YOM with HIV on ART has this recurrent dry pruritic rash in his right elbow flexure:
15/What is the most likely diagnosis?
16/Answer: Atopic dermatitis
🔸Seen in 30-50% of PWH
🔸Common in those with CD4 nadir < 200
🔸Pathogenesis: hypereosinophilia, high levels of IgE secondary to Th1-Th2 imbalance
🔸Rx: topical steroids, antihistamines
🔸Recurs even with appropriate ART
17/
38YOF with worsening itchy scaly patches on her arms and legs over several years. She recently tested positive for HIV (CD4=37).
18/What is the most likely diagnosis?
19/Answer: Xerosis (severe dry skin)
🔸Very common (20% in PWH)
🔸Severity correlates with declining CD4
🔸Pathogenesis: changes in microcirculation, decreased skin innervation, altered mast cell population in skin
🔸Tx: ART, emollients, antihistamines
20/
42YOM with HIV started ART 3 months ago. He recently developed this intensely itchy follicular papular eruption involving his face, chest, and back:
21/What is the most likely diagnosis?
22/Answer: Eosinophilic folliculitis
🔸⬆️risk if CD4<250
🔸Can present as IRIS
🔸Pathogenesis: ⬆️IL-4 and IL-5 👉Peripheral eosinophilia, elevated IgE in 25-50%
🔸Tx: ART, topical steroids, phototherapy, itraconazole
23/
No clues for this one. Picture = 1000 words.
24/What is the most likely diagnosis?
25/Answer: seborrheic dermatitis
🔸Inflammation of sebaceous glands 👉erythema, scaling of central face, nasolabial folds, scalp
🔸Seen in up to 80% of PWH 👉worse w/ ⬇️CD4
🔸Pathogenesis: ? Hypersensitivity to fungus
🔸Tx: topical antifungals, oral itraconazole if severe
26/Today, we covered the primary manifestations of skin diseases in HIV.
Stay tuned for part 2 in the upcoming weeks!
27/Additional references:
pubmed.ncbi.nlm.nih.gov/21261982/
pubmed.ncbi.nlm.nih.gov/16377853/
iasusa.org/dermatologic-m…
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