AIDS and the skin

Acquired immune deficiency syndrome (AIDS) is caused by the HIV which affects immunocompetent cells including CD4 T-cells and macrophages. Dermatological involvement in AIDS has been appreciated since the first recognition of the disease (Bunker and Gotch, 2004). The proportion of patients with skin complications and the number of these manifestations in any one patient increase as HIV progresses and AIDS develops. The incidence and severity of several common dermatological conditions covered in this section, for example herpes simplex and herpes zoster, folliculitis, viral warts, mollusca, tinea and scabies, are increased in patients with HIV, often in correlation with their CD4 count. Skin disease may therefore provide the first suspicion of the diagnosis of HIV infection and may also present with unusual signs and symptoms, coexist with other pathologies or be altered by treatment, all of which may make them a challenge to diagnose and manage. As highlighted by Bunker and Gotch (2004), good history-taking and examination is therefore vital.