Inflammatory skin conditions
Eosinophilic folliculitis
Eosinophilic folliculitis typically occurs in HIV-infected persons with helper T cell counts below 200. Intensely pruritic, edematous, urticarial papules and pustules appear in crops on the trunk or face or both. Cultures and histologic examination for infectious agents are negative, but a relative peripheral eosinophilia may be present.
Astemizole ( Hismanal), 10 mg daily has been used with limited success, but concurrent imidazole or erythromycin therapy is contraindicated with astemizole because of the risk of cardiac arrhythmia. Ultraviolet phototherapy is also beneficial. Itraconazole in a dosage of 200 to 400 mg daily is sometimes beneficial. Permethrin 5% (Elimite) used every other day from the waist up may bring improvement in some patients: Permethrin kills the Demodex mite, which may be the etiologic agent in eosinophilic folliculitis. Canadian Prescriptions Drugs
Drug reactions
The incidence of adverse reactions TMP-SMX is very high. Most reactions occur in the second week of therapy, and the rash is a maculopapular/morbilliform reaction, beginning in the groin and pressure areas and quickly generalizing. Cutaneous eruptions occur in 48% of treated patients. Resolution of the skin rash during therapy occurs in 33%, and the remaining patients have progressive toxicity, necessitating discontinuation of the drug.
The use of systemic corticosteroids in treating PCP reduces the rate of drug eruption from TMP-SMX. Other drug-induced hypersensitivity reactions include urticarial reactions, exfoliative erythroderma, fixed-drug eruption, erythema multiforme, and toxic epidermal necrolysis. These reactions are most often due to antibiotics, especially TMP-SMX and the penicillins.
Scabies
Scabies usually presents with pruritic papules with accentuation in the intertriginous areas, genitalia, and fingerwebs. Gamma-benzene hexachloride (lindane) applied from the neck down for 8 to 24 hours is usually curative; however, that lindane may result in peripheral neuropathies in HIV-infected patients, particularly in those with CD4 < 200. In patients with scabies who have not responded to gamma-benzene hexachloride therapy, 5% permethrin cream (Elimite), used in the same method as lindane, is safe and effective. cheap soma
True crusted ( Norwegian) scabies may occur in patients with advanced HIV disease. Norwegian scabies is nonpruritic and appears as thick crusts. The crusts are highly contagious. Treatment with Elimite should be repeated at least weekly until cutaneous manifestations clear. Ivermectin, 6% precipitated sulfur ointment, daily should be added to the Elimite therapy.