Mucocutaneous signs of HIV disease: A guide to early detection part 1: Infections and infestations

The first clinical signs of HIV infection often appear as skin ailments; many of these have unusual features, and some may be life-threatening. Up to half of HIV-infected patients suffer from herpesvirus infection. Herpetic lesions may affect other organs besides the skin, inducting the eye, esophagus, and lung. HIV-seropositive patients exposed to varicella-zoster virus (VZV) must be treated with hyperimmune globulin, VZV vaccine, or high- dose acyclovir. Bacterial skin diseases, such as folliculitis, impetigo, and cellulitis, are common; bacilliary angiomatosis is seen almost exclusively in HIV-infected patients and can mimic Kaposi's sarcoma. Scabies and other ectoparasitic infestations are also frequent; suspect mites if severe, intractable pruritus and a scaly chronic dermatosis are present. Cutaneous fungal infections, such as dermatophytosis, may assume a number of guises; proximal white subungual onychomycosis is seen almost exclusively in immunocompromised patients.