Dermatologic Manifestations of HIV Infection - part 1
Infectious cutaneous conditions
Staphylococcus aureus infections
Staphylococcus aureus is the most common bacterial skin infection in persons with HIV disease.
Bullous impetigo. Bullous impetigo is most common in hot, humid weather, presenting as very superficial blisters or erosions, most commonly seen in the groin or axilla.
Ecthyma is an eroded or superficially ulcerated lesion with an adherent crust. Purulent material is present under this crust.
Folliculitis
Folliculitis due to S. aureus occurs most commonly in the hairy areas of the trunk, groin, axilla, or face. Gram’s stain and culture of pustules confirms the diagnosis.
Often the follicular lesions of the trunk are intensely pruritic and may be mistaken for scabies. About 50% of HIV-infected persons with scabies have coexistent S. aureus folliculitis.
Treatment of cutaneous staphylococcal lesions
Very superficial lesions, like bullous impetigo, often respond to an antistaphylococcal antibiotic, such as dicloxacillin (500 mg given PO qid) or 7-10 days. Combinations of antibiotics, especially a dicloxacillin or cephalexin ( Keflex) plus rifampin (600 mg once daily), are often necessary.
Washing the infected area once daily or every other day with an antibacterial agent (Hibiclens, Betadine) helps remove crusts, dries lesions, and decreases surface bacterial concentration. Topical antibiotics (clindamycin 1% or erythromycin 2% solutions) applied twice daily may be used.
Loculated abscesses must be incised and drained when fluctuant. Intravenous antibiotics are required when significant cellulitis of or symptoms of bacteremia are present, appropriate. Intranasal mupirocin may reduce carriage rate and prevent relapses. Chronic oral antibiotics may be required to prevent relapse.