Skin problems are common in HIV/AIDS patients. You need to differentiate minor skin problems from other severe opportunistic diseases that also present with skin manifestations, but need urgent referral. For instance, fungal infections in the blood and internal organs such as cryptococcosis (Stage 4; see Table 21.1), may also result in nodular skin lesions. The following minor skin problems are indicative of WHO clinical stage 2, and you should refer PLHIV presenting these to the nearest health centre for treatment.
Itching skin rash may be due to the following two conditions:
Seborrhoea is a scaly skin rash that usually appears on the edge between face and hair, on the side of the nose, or on the chest. The areas with the rash often contain greasy or oily scales, and are surrounded by some redness of the skin (Figure 21.2).
Figure 21.2 Scaly skin rash on the face, mainly around the nose, caused by seborrhoea. (Photo: WHO, 2007, as in Figure 21.1)
Prurigo (Pruritic Papular Eruptions, PPE) is an itchy skin eruption on the arms and legs. Often it has small papules (small, solid and usually inflammatory elevations of the skin) and scratch marks. Once cleared, papules may leave dark spots with light centres (Figure 21.3).
Figure 21.3 Multiple papular rash caused by PPE. (Photo: WHO, 2007, as in Figure 21.1)
Herpes zoster ('almaz bale chira' in Amharic) is a painful blistering skin rash caused by the herpes zoster virus (also known as varicella zoster). It is characterised by vesicles (fluid-filled blisters formed in, or beneath, the skin) that appear in only one area on one side of the body, usually on the chest (Figure 21.4), but also on a leg, arm or one side of the face or the back. Vesicles then turn into lesions, and later into crusts that may become inflamed, and even infected. Vesicles usually heal in two to three weeks and they rarely reappear, but there is often scarring after healing. Note that vesicles are accompanied by intense shooting pain, and sometimes the pain may continue after the lesions heal.
Figure 21.4 Vesicles around the lower chest area, caused by herpes zoster. (Photo: WHO, 2007, as in Figure 21.1)