The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 9: Dermatologic ProblemsTable 9-3: Cutaneous Signs of Dangerous Adverse Drug ReactionsSyndromeClinical signs, symptomsConstitutional 26 picas symptomsFever, rigors, intolerable pruritus and skindiscomfort, etc.VasculitisMucous membrane involvementBlister formationPalpable purpura or new ulcers, digitalinfarcts, livedo reticularis or unexplainedsubcutaneous nodules or nonpruritic, painfuland persistent urticariaHemorrhagic erosions of the oral mucosasuggestive of Stevens-Johnson syndrome orthe deadly toxic epidermal necrolysis, whichpresents with generalized skin sloughingDiffuse or localized bullaeHypersensitivity syndromeMay present as a morbilliform eruption butwith severe systemic symptoms including highfever and organomegaly with elevated LFTsand peripheral eosinophilia.IXAcute generalized exanthematous pustulosisLupus-like syndromeErythrodermaAngioedemaA diffuse pustular eruption (papules filled withwhite/yellow pus)Malar rash, photosensitivity combined withother symptoms suggestive of systemic lupuserythematosusA generalized, severe reddening of the entireskin surfaceSwelling of the face, lips and oropharyngealmucosa. If there is airway compromise itbecomes a medical emergency requiringimmediate ventilatory support.IntertrigoIntertrigo is a general term that describes inflammation and/or infection of the intertriginousareas, specifically the perineum, inframammary region, axillae, and redundant skin foldsin obese individuals. Three major infections—dermatophyte or tinea infections, Candida infections,and erythrasma, which is caused by Corynebacteria—all thrive in the warm, moistareas of the intertriginous spaces and are seen in both the healthy and the AIDS populations.Clinical PresentationTinea infections classically present with erythematous patches showing a more active,slightly elevated, scaling border as the fungus advances at the outer edges. The border isfrequently scalloped and well defined. The scrotum is hardly ever involved in tinea infections.This is in contrast to Candida infections, which are generally more moist, weepy,and erythematous, with the characteristic satellite lesions at the periphery of the largepatch. Erythrasma is much less common than the above but is important to recognizebecause of its clinical similarity and because, as a bacterial infection, will not respond toU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 199