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Any type of opportunistic infection is more likely in patients with AIDS and will generally be more severe. An itching, inflammatory folliculitis occurs in many cases. The cause is unknown, but it is possible that Demodex spp. play a part.

Fungal infections

Superficial fungal infections are often much more extensive and invade more deeply into the dermis than usual. There may also be granuloma formation.

Deep fungal infections that are not normally seen in healthy individuals occur in AIDS patients as opportunistic infections. Cryptococcus neoformans and Histoplasma capsulatum may cause inflammatory papular and necrotic lesions, particularly in the later stages of the disease.

Candidiasis is common and often associated with bacterial infections. It occurs particularly in and around the mouth, on the palate, and in the pharynx. It commonly causes severe vulvovaginitis in infected women.

Pityrosporum organisms occur more frequently and may produce widespread pityriasis versicolor on the trunk or extensive folliculitis.

Skin changes in AIDS

• Seborrhoeic eczema

• Fungal infections

• Bacterial infections

• Viral infections

• Kaposi's sarcoma

• Oral hairy leukoplakia

Pseudomembranous Candida
Pseudomembranous candida

Bacterial infections

Impetigo may be severe, with particularly large bullous lesions occurring.

Mycobacteria may produce widespread cutaneous and systemic lesions. Varieties of mycobacteria that do not normally infect the skin may cause persistent necrotic papules or ulcers.

Viral infections

Both herpes simplex and herpes zoster infections may be unusually extensive, with large individual lesions. In the case of herpes zoster the affected area may extend beyond individual dermatomes. Sometimes persisting ulcerated lesions occur.

Molluscum contagiosum lesions are frequently seen. They are much larger than usual and develop over quite large areas of skin. They are readily identified as small, firm papules with an umbilicated centre. When very large individual molluscum lesions occur they may be due to localised fungal infection, particularly cryptococcus and histoplasmosis.

Viral warts may be large and extensive. Perianal and genital warts due to the human papilloma virus (HPV) are common and may be associated with intraepithelial neoplasia of the cervix and sometimes invasive perianal squamous cell carcinoma. The warts tend to become smaller as the immune status of the patient improves with the treatment. It is not unusual for florid viral warts to develop in the mouth.

Cryptococcus Perianal
Aciclovir-resistant perianal herpes simplex infection

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