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 ProblemsTreatmentMiliaria is a self-limiting condition and requires no specific treatment besides reducingimmobilization26 picasby frequent decubitus changes, and reducing overheating and heat entrapmentby avoiding excessive clothing. Grover’s disease, if chronic, can be treated withClass IV topical corticosteroids twice daily. For persistent cases, alternatives include a 6-month course of isotretinoin or PUVA.Decubitus UlcersThe bedridden patient in any hospital or hospice environment is at constant risk for primaryskin breakdown. This represents a significant risk in this immunologically debilitated populationbecause open wounds, chronic diarrhea, and warm, moist environments are fertile groundfor superinfection. The diagnosis and treatment of decubitus ulcers will be discussed separately.(See Chapter 25: Prevention of Skin Breakdown.)CONCLUSION■ A careful history and a comprehensive physical examination with review of pertinent medications,medical history, and exposures are all essential to making a rapid diagnosis of the manypotential dermatologic conditions that may arise in the AIDS patient. For theimmunocompromised patient, it is essential that topical steroids not be given indiscriminatelywithout accurate diagnosis. When in doubt, a simple biopsy and referral to a dermatologist willsave the patient critical time spent on topical therapies that, through their ineffectiveness, mayonly prolong patient suffering.IXU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 201