Abstract

PIP: The World Health Organization clinical criteria for AIDS diagnosis in Africa include Kaposi's sarcoma, Herpes zoster, Herpes simplex, and pruritic maculopapular rash, which have a predictive value for HIV seropositivity of 71-98%. Skin conditions may be classified as: 1) generalized dermatitis, 2) bacterial, fungal, viral, and parasitic infections, and 3) skin tumors. Pruritic maculopapular rash (prurigo) is often the first outward sign of HIV infection. Soothing preparations such as calamine lotion or E45 emollient cream can be applied. Occasionally antihistamine may be necessary, e.g., 10 mg of chlorpheniramine 8 hourly. Skin lesions may become secondarily infected with bacteria; usually Staphylococcus aureus and Streptococcus species. Persistent folliculitis or carbuncles should be treated with flucloxacillin 250 mg QDS for 7 days. In HIV/AIDS fungal infections often develop secondary infection. Candidiasis (thrush) is caused by yeasts, mainly Candida albicans and a small percentage by Tolurosis glabrata. Many HIV-infected patients suffer from seborrheic dermatitis. Fungal diseases more typically present as ringworms of the scalp (Tinea capitis). Whitfield's ointment is effective for ringworm. Antifungal creams such as miconazol or clotrimazole and systemic antifungal tablets such as ketoconazole, fluconazole, and itraconazole are also effective. Gentian violet lotion twice daily and Acyclovir tablets, 200 mg 5 times daily for 5 days, may help to reduce secondary Herpes simplex infection. HIV has been associated with an increased incidence of Herpes zoster (shingles). It is often necessary to give analgesics like aspirin or paracetamol to control the pain. Gentian violet paint may help to prevent secondary infection. When shingles affects the eye, Acyclovir tablets (800 mg 5 times daily) should be given. Kaposi's sarcoma affects wider age groups, and it is disseminated and more aggressive than the endemic type. Treatment options include radiotherapy and systemic cytotoxics such as vincristine. Intralesional injections of the drug interferon have also given successful results with some patients.