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Dermatologic Care of the HIV-Infected Patient
I. Clinical Evaluation of Cutaneous Disease
A. As the degree of immunodepression advances in the HIV-infected patient, the greater the likelihood of an unusual dermatologic presentation and/or disease course.
B. Early HIV disease (CD4 >400/µL)
1. Usually only skin disease typical of the risk factors for HIV disease are seen (eg, genital HSV, genital warts).
2. At this stage human papilloma virus (HPV) infection may be resistant to therapy.
3. Kaposi's sarcoma may sometimes appear at this stage. Less commonly, thrush, oral hairy dermatology of AIDS, HIV, rashes, skin disorders, scabies, papilloma, condyloma leukoplakia, and herpes zoster, Kaposi sarcoma, cat scratch disease, condyloma may develop.
C. Early Symptomatic Phase (CD4 200-400 cells/µL)
1. Disorders of subtle immune imbalance occur, including candidiasis, oral hairy leukoplakia, herpes zoster, psoriasis, seborrheic dermatitis, and atopic dermatitis occur at this stage.
2. Response to treatment is usually normal at this stage.
D. Early Stage AIDS (CD4 <200 cells/µL)
1. Opportunistic infections may present on the skin (cryptococcosis, histoplasmosis), and become chronic (chronic herpes ).
2. HIV specific inflammatory diseases also appear at this stage. Pruritus is very common with a CD4 less than 200-300.
3. Drug hypersensitivity, scabies and itchy folliculitis are manifestations of the enhanced reactivity seen in AIDS.
E. Late Stage AIDS (CD4 <50/µL). Bizarre skin disease occur. Treatment failure, drug resistance and chronicity are characteristic of this stage.
II. Infectious Cutaneous Disorders
A. Bacterial Infections
1. Staphylococcus aureus is the most common cutaneous bacterial pathogen. Staphylococcus aureus infection may cause folliculitis, bullous impetigo, ecthyma, abscesses, hidradenitis suppurativa-like plaques, and cellulitis. Staphylococcus aureus is usually susceptible to trimethoprim/sulfamethoxazole; therefore, it is less common in patients