Fissuring within plaques can occur when lesions are present over joint lines or on the palms and soles. Gentle scraping accentuates the scale (vigorous scraping causes pinpoint bleeding – Auspitz’ sign). OF HAND. Acute episodes of plaque psoriasis may evolve into more severe disease – eg, pustular or erythrodermic psoriasis. Photochemotherapy uses a photosensitising drug (eg, PUVA) to treat patients with more extensive or resistant disease. Therapy is usually administered 2-3 times per week, with maintenance treatments every 2-4 weeks until remission. Patients with HIV disease often have several simultaneous or sequential cutaneous conditions with a progressively more intransigent clinical course, a key to suspecting underlying HIV infection. When cellulitis of any significance or symptoms of bacteremia are present, hospital admission for treatment with intravenous antibiotics is appropriate. Once severely immunosuppressed, HIV-infected persons often experience chronic lesions that continue to expand and form large, crusted erosions 2 to 10 cm or larger in diameter (Figure 4). In our experience, most HIV-infected patients referred for a refractory intertriginous eruption have seborrheic dermatitis or psoriasis of the groin. HIV-infected patients can pose diagnostic challenges, as their altered immune status may lead to atypical presentations of common cutaneous diseases, as well as the occurrence of uncommon or opportunistic skin disorders. Management of cutaneous disease in sero-positive patients can also be challenging, as the dermatological manifestations may be more severe, may recur with greater frequency, and may be refractory to standard treatment.
From warts to scabies to malignancies, skin disorders are more common and more aggressive in HIV-positive patients than others, Dr. Cases of severely resistant molluscum, unusual lesions or cases in which systemic signs are present should be biopsied with appropriate stains to rule out cryptococcosis. However, because a traumatized nail is more vulnerable to fungi than one intact, psoriatic nails are often co-infected with tinea, yeasts or aspergillus. The disease most commonly manifests on the skin of the elbows, knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis. The diagnosis of psoriasis is clinical, and the type of psoriasis present affects the physical examination findings. Guttate psoriasis: Presents predominantly on the trunk; frequently appears suddenly, 2-3 weeks after an upper respiratory tract infection with group A beta-hemolytic streptococci; this variant is more likely to itch, sometimes severely. Intralesional corticosteroids: May be useful for resistant plaques and for the treatment of psoriatic nails. Since early diagnosis and treatment of HIV can help prevent serious sequelae in the source patient and further dissemination of HIV to sexual contacts, it is considered here as an emergency. Though HIV-associated psoriasis of varying severity can manifest at any CD4 T cell count, it often presents later in the course of disease when CD4 numbers decrease to below 100-350. Erythematous and atrophic lesions are common in older patients with HIV and present as red ulcers and erosions;
Skin disorders are commonly encountered in HIV-infected patients, and they may be the first manifestation of HIV disease. In most cases, treatment modality of skin diseases in HIV-positive patients is similar to that in HIV-negative ones. Although phototherapy can alleviate pruritus or improve psoriasis in HIV-infected patients, its use is hampered by its upregulation of HIV transcription. 2-5 Numerous studies demonstrate that skin symptoms occur at every stage of HIV infection; there are some skin diseases that present almost exclusively in HIV/AIDS patients, and other, more common skin conditions that tend to be worse or more difficult to manage in infected patients. 8 In a subgroup of study patients with xerotic eczema, the barrier abnormality was more significant; these patients also displayed notably reduced stratum corneum hydration and a higher surface pH compared to HIV patients without eczema. In addition to the clinical severity of psoriasis in the setting of concomitant HIV or AIDS, the disease is often refractory to treatment, and finding effective therapeutic options may be more difficult. Dermatologic Signs of Systemic Disease Online Medical Reference – from diagnosis through treatment options. Differential diagnosis includes psoriasis, atopic dermatitis, allergic or irritant contact dermatitis, and dermatophyte (tinea) infections. 3), or hives, is most often caused by medication (commonly penicillin or other antibiotics, sulfa drugs, aspirin) or food (shellfish, nuts, chocolate), and less often by infection.