The skin and HIV: no superficial matter

The vast majority of HIV-infected patients experience some type of skin disorder; these may broadly be categorized as infectious, neoplastic, or inflammatory. Additionally, primary pruritus afflicts a considerable percentage of HIV-infected individuals, and an attempt should be made to identify potential underlying triggers. Chronic itch, whether related to an underlying cutaneous, systemic, or psychiatric illness, can have a profound effect on quality of life. Therapy for inflammatory skin disorders may involve initiation of antiretroviral therapy in those who have not yet started such treatment, oral antihistamines, topical corticosteroids, topical antipruritic agents, and skin moisturizers. Because topical corticosteroids are often a necessary component of the therapeutic armamentarium for skin diseases, practitioners are encouraged to become familiar with the appropriate indications, strengths, and formulations of available preparations. In some instances, psychiatric medications or phototherapy may be necessary for the treatment of HIV-associated skin disorders, particularly for patients experiencing refractory itch. Although psoriasis is not more frequent among HIV-infected patients than in the general population, it can be more severe and debilitating for those who are HIV infected. Our understanding of psoriasis in the setting of HIV infection has evolved and new therapies for psoriasis have recently become available. This article summarizes a presentation by Sareeta R. S. Parker, MD, at the IAS-USA continuing education program held in Atlanta, Georgia, in April 2014.