Skin manifestations in AIDS patients.

Skin lesions occur in virtually all patients during the unfolding evolution of their HIV infection--usually a succession of conditions reflecting the gradual decline of immunity. Hairy leucoplakia can occur at any stage and in all risk groups. Kaposi's sarcoma is seen only in homosexually acquired AIDS. A transient rash may accompany the initial HIV seroconversion illness, but may go unnoticed. Documented examples show macular red oval lesions, similar to pityriasis rosea, but extending onto the face, palms and soles, preceded by a flu-like illness with lymphadenopathy and lymphopenia simulating glandular fever. Seroconversion occurs within weeks. During the following weeks or years the gradually declining immunity may only be documented by decreasing numbers of CD4 positive lymphocytes with the emergence of 'idiopathic' inflammatory skin conditions (eg, seborrhoeic dermatitis, psoriasis), as well as autoimmune conditions (eg, thrombocytopenia, morphoea or alopecia areata). As immunity itself declines, skin infections emerge. Shingles affects over 25% of HIV-positive patients--sometimes involving numerous dermatomes, accompanied by multiple distant chicken pox lesions and followed by post-herpetic neuralgia. Onychomycosis and tinea pedis are universal, but sometimes occult patterns with follicular lesions due to Trichophyton rubrum may spread widely over the beard and chest. Uncomfortable mucosal candidosis, sometimes with oesophageal extension, may only become controllable with oral imidazoles. Molluscum contagiosum may be seen in hundreds over large areas, whole soles can be shod in verrucae and vulgar warts appear in the most unusual sites, for example on the palate or up nostrils. Dry skin develops into acquired ichthyosis and eczema crackelé.(ABSTRACT TRUNCATED AT 250 WORDS)