clobetasol and HIV-Infections

Individuals who are infected with Human Immunodeficiency Virus (HIV) suffer from numerous dermatoses. These disorders are often more severe than those observed in non HIV-infected persons afflicted with the same diseases. Lichen planus (LP) is a chronic inflammatory papulosquamous skin disorder. Herein, the diagnosis and treatment of a 40-year-old HIV+ Kenyan man afflicted with hypertrophic lichen planus (HLP) is described. In this case, lesions of HLP were widely distributed across the trunk and extremities, having become of such thickness on the dorsal surfaces of the hands and fingers as to make normal use of hands impossible. A significant distinguishing feature of this patient is prior history of tuberculosis, which is a known trigger for lichenoid skin lesions.

Topics: Adult; Anti-HIV Agents; Clobetasol; Drug Combinations; Hand Dermatoses; HIV Infections; Humans; Lamivudine; Lichen Planus; Male; Nevirapine; Pruritus; Stavudine; Treatment Outcome; Tuberculosis, Pulmonary

A case of psoriasis and psoriatic arthritis in a 38-year-old white male patient infected with human immunodeficiency virus (HIV) treated safely and effectively with mycophenolate mofetil (MMF) is reported. Treatments for psoriasis and psoriatic arthritis are manifold, including topical, oral, intramuscular, intravenous, and subcutaneous therapies. These indicated treatments for psoriasis and psoriatic arthritis result in suppression of the immune system.

Topics: Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antiretroviral Therapy, Highly Active; Arthritis, Psoriatic; Clobetasol; HIV Infections; Humans; Male; Middle Aged; Mycophenolic Acid; Psoriasis; Skin

Lymphomatoid papulosis (LyP) is a rare cutaneous lymphoproliferative condition characterized by a chronic, recurrent eruption of papules and nodules that undergo spontaneous regression. The disorder is usually clinically benign; with a minority of cases progressing to malignant lymphoma. LyP is divided into two subtypes based on histologic appearance. Type A resembles Hodgkin's disease with up to 20% of large CD30+ lymphocytes. Type B resembles mycosis fungoides showing an infiltrate of CD4+ lymphocytes and scattered CD30+ cells. Clinically LyP often resembles pityriasis lichenoides et varioliformis acuta but has a strikingly different histological appearance. Histologically, LyP resembles lymphoma (anaplastic T-cell or Hodgkin's) but is distinguished by its benign course. Here we present a case of LyP in a severely immune-repressed HIV-positive patient. This patient presented with pruritic papules involving the upper extremities and a CD4+ T-cell count of 4. Histopathologic examination showed a dense superficial dermal infiltrate comprising normal-sized lymphocytes admixed with larger lymphocytes. Immunophenotyping showed most of the lymphocytes to be CD3+ (T cells). The scattered larger cells were CD30+. The smaller lymphocytes were CD8+ rather than CD4+ as expected for non-HIV-appointed LyP. This may be because of the immune disregulation of HIV disease and the absolute and relative paucity of CD4+ T cells relative to CD8+ T cells.

Topics: Adult; Clobetasol; Glucocorticoids; HIV Infections; Humans; Lymphomatoid Papulosis; Male

We report six HIV patients who developed painful periungual inflammation of several nails during treatment with the antiretroviral drugs indinavir and lamivudine. The lesions appeared 2-12 months after starting treatment. The occurrence of paronychia in HIV patients has recently been reported in two groups of patients receiving either indinavir or lamivudine. Dermatologists should be aware of this recently reported and probably not uncommon side-effect of antiretroviral treatment in order to avoid an invasive approach to the nail lesions.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-HIV Agents; Anti-Inflammatory Agents; Clobetasol; Drug Therapy, Combination; Female; Glucocorticoids; HIV Infections; Humans; Indinavir; Lamivudine; Male; Middle Aged; Mupirocin; Paronychia

Recurrent aphthous ulcers in patients with HIV infection can cause significant morbidity, which makes successful diagnosis and treatment imperative. We have found that the diagnostic paradigm for recurrent aphthous ulcers in HIV-seronegative patients, which is based on the ulcers' clinical appearance, location, absence of other ulcer-causing pathogens or pathogenic processes, and response to therapy, may be successfully applied to recurrent aphthous ulcers in HIV-infected patients. However, one must be alert for ulcers with uncommon causes as well as ulcers with common causes that have atypical clinical appearances that may mimic recurrent aphthous ulcers. The topical glucocorticoids, which are used to treat recurrent aphthous ulcers in HIV-seronegative patients, proved very effective in HIV-infected patients for treatment of herpetiform and minor ulcers and most major ulcers and were without notable side effects. A few severe cases of major recurrent aphthous ulcers required treatment with systemic prednisone, and some side effects were encountered.

Topics: Acquired Immunodeficiency Syndrome; Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Dexamethasone; Female; Fluocinonide; Glucocorticoids; HIV Infections; Humans; Male; Middle Aged; Prednisone; Stomatitis, Aphthous