Photosensitivity as the presenting illness in four patients with human immunodeficiency viral infection

A multitude of skin lesions have been reported in individuals with human immunodeficiency virus (HIV) infection. Some of them, eg, severe seborrheic dermatitis and herpes zoster infections, may predate the onset of the diagnostic criteria for the acquired immunodeficiency syndrome and may actually raise the suspicion of HIV infection in healthy-appearing individuals. We have recently evaluated four individuals who presented with a severe idiopathic photosensitivity of eczematous morphologic features who eventuated in a diagnosis of HIV seropositivity. Four individuals who presented with an eczematous eruption of sun-exposed skin were referred to the Environmental Dermatology Unit of Columbia-Presbyterian Medical Center (New York, NY) for evaluation of possible photosensitive disease. They were examined and underwent photobiological testing (minimal erythema dose testing and photopatch testing) to confirm and classify their suspected photosensitivity.

All four patients fulfilled the criteria for chronic actinic dermatitis, a rare idiopathic photosensitivity characterized by debilitating, unremitting dermatitis with eczematous or lymphomalike histologic features and reproduction of lesions by small quantities of mid-wave UV-B radiation (290 to 320 nm). All four individuals were HIV seropositive and CD4 counts were markedly suppressed in all four. The photosensitivity predated the finding of seropositivity and the diagnosis of acquired immunodeficiency syndrome in all four patients.

The presentation of healthy-appearing individuals with photodistributed dermatitis of unknown cause should alert the physician to the possibility of HIV infection.