Many dermatological problems are listed in this chapter as occurring more frequently in HIV disease. Many appear to be related to uninhibited growth of fungi and viruses on the skin and this is perhaps not surprising as we know that these patients have defective cell-mediated immunity and are particularly susceptible to systemic infection with fungi and viruses. Serious bacterial infections are relatively rare in AIDS and this is reflected dermatologically with only a slightly increased incidence of such conditions as impetigo and cellulitis.
Many of the dermatological conditions however do not clearly relate to secondary infection and perhaps reflect other problems of altered immune function and nutrition. Widespread eczema and allergic phenomena are common—just as they are in children born with primary T-cell deficiencies. Cellular immunity must play a vital role in the defence and possibly nutrition of the skin—a role we are only just beginning to understand.
It is important for physicians not to ignore dermatological problems when dealing with patients with HIV disease. Skin disease nearly always carries psychological investment with any patient and this could not be more true than with this group of patients. Worried by their diagnosis, skin signs are often their only indication of disease apart from vague tiredness. They concentrate on their spots and rashes and desperately seek successful treatment. Their skin disease may be severe and they may suffer horribly from widespread skin involvement. Apart from the folliculitis nearly all the skin disease they fall prey to is easily treated—the secret is to pay attention to it and to prescribe adequate amounts of treatment and on a continuing basis if necessary.
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