Simple habits, like gentle cleansing and avoiding harsh or irritating products, can go a long way in managing and preventing flare-ups to the skin. - UNSPLASH
The human immunodeficiency virus (HIV) is well-known for its impact on the immune system and its effects on other systems in the body. One area that is particularly vulnerable in people with HIV is the skin.
Skin issues are often one of the first visible signs of HIV infection and according to Sunway Medical Centre, Sunway City’s consultant dermatologist Dr Sharifah Rosniza Syed Nong Chek, an estimated 90% of individuals with HIV experience skin-related symptoms at some point.
Understanding the types of skin conditions associated with HIV, their symptoms and how to manage them can make a significant difference in maintaining health and quality of life for people living with HIV.
Why HIV affects the skin
HIV weakens the immune system, making it more difficult for the body to defend itself against infections, including those affecting the skin, says Dr Sharifah Rosniza.
While modern antiretroviral therapies (ART) have greatly improved the management of HIV, some skin conditions still pose challenges and can cause discomfort, pain, or, in some cases, serious health risks.
Skin manifestations of HIV infection can appear as early as three weeks after HIV infection. “The patient can experience what we call an acute HIV rash.
“This rash is associated with other symptoms such as fever, sore throat, enlarged lymph nodes, maybe even nausea, vomiting and diarrhoea. The rash is generalised and lasts for about two weeks before it goes away,” she says.
There is also a latent period (incubation period) that can last for a while. Once the HIV infection has established itself, other types of skin disorders can then manifest and Dr Sharifah Rosniza says that these can be broadly divided into three types:
- Inflammatory skin conditions: Those with specific association to HIV include eosinophilic folliculitis and pruritic papular eruption of HIV; the other is not specific to HIV and can affect anyone, such as psoriasis and seborrheic dermatitis.
- Infections: People with HIV are more susceptible to various infections including bacterial (such as Staphylococcus infections), viral (such as herpes simplex and herpes zoster) and fungal (like candidiasis and talaromycosis).
- Neoplastic (cancerous) skin conditions: HIV-infected individuals are at a higher risk for certain skin cancers due to immune suppression. These include Kaposi sarcoma, basal cell carcinoma and squamous cell carcinoma.
Dr Sharifah Rosniza emphasises the importance of consistency with antiretroviral therapy (ART) to help reduce the incidence of skin complications.
Common skin disorders
There are several skin disorders related to HIV that vary in appearance and severity depending on the stage of HIV infection and the level of immune suppression.
Some of the more common skin disorders related to HIV include:
1. Seborrheic dermatitis
Symptoms: Red, itchy and flaky patches, often on the scalp, face, eyebrows, or chest.
Cause and treatment: Seborrheic dermatitis is common and more severe in people with HIV and it can be caused partly by immunosuppression and an overgrowth of a natural skin yeast, Malassezia. Topical antifungals and topical corticosteroids are often effective and maintaining a proper skincare routine can help manage flare-ups.
2. Psoriasis
Symptoms: Scaly, red plaques, particularly on the outer elbows, knees, scalp and lower back.
Cause and treatment: Psoriasis may appear or worsen in individuals with HIV. Treatments include topical corticosteroids, tar-based therapies and other medications to reduce inflammation and control symptoms.
3. Molluscum contagiosum
Symptoms: Small, raised, pearly bumps on the skin.
Cause and treatment: Molluscum contagiosum is a viral skin infection that’s more common in those with HIV due to their lowered immunity. It can be treated with cryotherapy and will usually improve with the commencement of ART.
4. Fungal infections (e.g. candidiasis and tinea)
Symptoms: Itchy, red and sometimes scaly patches; in the case of oral thrush, white patches inside the mouth.
Cause and treatment: Fungal infections are particularly common in those with weakened immune systems. Antifungal medications, both topical and oral, are the primary treatment.
By raising awareness on skin conditions, we can foster a more understanding and supportive environment for those living with HIV. - UNSPLASH
Managing HIV-related skin conditions
Dr Sharifah Rosniza emphasises the importance of consistency with ART as it has essentially transformed HIV into a manageable chronic condition, significantly reducing the incidence of skin complications. By keeping the immune system functioning better, ART reduces the likelihood of opportunistic skin infections and other skin conditions.
Proper skincare and hygiene are important. Simple habits, like gentle cleansing, moisturising and avoiding harsh or irritating products, can go a long way in managing and preventing flare-ups. Sun protection is also a very important routine to prevent skin complications and reduce risk of skin cancers.
Because skin conditions are often the first visible sign of HIV progression, it’s essential for individuals with HIV to monitor their skin health closely. Routine skin checks, either self-examinations or by a healthcare provider, can lead to early detection of potentially serious conditions.
Additionally, regular communication with healthcare providers allows for timely adjustments to HIV treatment plans if side effects or immune responses impact skin health.
Raising awareness and reducing stigma
Living with HIV presents many challenges, but skin issues shouldn’t be ignored or underestimated. Dr Sharifah Rosniza emphasises that with advancements in HIV treatment and a proactive approach to managing skin health, individuals with HIV can achieve a high quality of life.
World AIDS Day is not only a time to educate people about HIV and its symptoms but also to combat stigma. Skin conditions can be highly visible, making people living with HIV more vulnerable to social stigma and discrimination.
By raising awareness and providing accurate information, we can foster a more understanding and supportive environment, encouraging people to seek help without fear of judgement.
