Other manifestions

Oral hairy leukoplakia occurs in 30-50% of patients with AIDS. It is characterised by an overgrowth of epithelial plaques on the sides of the tongue with a verrucous surface and a grey/white colour. It is believed to be due to a proliferation of the Epstein-Barr virus.

Infestations with various organisms is not uncommon and the severe widespread crusted lesions of Norwegian scabies may

Kaposi's sarcoma

Kaposi's sarcoma is associated with the later stages of AIDS but can occur earlier. It is associated with herpes virus type 8. It often presents with small polychromic macules on the face, palate, trunk or groin which vary from red and purple to brown. They then develop into larger livid plaques, involving the trunk, limbs, and face, and also the oral mucosa. They are most common on the palate and nose. Sometimes the lesions are very aggressive.

B cell lymphoma may occur in the skin in 10% of AIDS patients. There is also an increased incidence of basal cell and squamous carcinomas.

Oral hairy leukoplakia

Kaposi's sarcoma of the hard palate

Oral hairy leukoplakia

Kaposi's sarcoma of the hard palate

Drug rashes

Reactions to sulphonamides and antibiotics are not uncommon, usually presenting as a maculopapular eruption. Occasionally this can be severe and associated with Stevens-Johnson syndrome. Myopathy may occur as a reaction to zidovudine.

Further reading

Adler MW. ABC of AIDS, 4th ed. London: BMJ Publishing Group, 1997

Penneys NS. Skin manifestations of AIDS, 2nd ed. St Louis: Mosby, 1995

occur.

All the above manifestions of AIDS become less marked as the CD4 count improves with treatment.

AIDS may thus present with a wide variety of skin conditions, commonly with several present at the same time. Any unusually florid skin condition that is resistant to treatment should raise the suspicion that HIV infection may be present.

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