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

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 25: Prevention of Skin BreakdownPERIANAL HERPES■ Although pressure is often overlooked as a causative factor in skin breakdown, the reversecan sometimes26 picasbe true. That is, ulcers may be assigned a diagnosis of pressure ulcers when infact pressure may not be the root cause.One commonly misdiagnosed condition is herpes simplex ulcer infections, especially perianalherpes. Because of their location these ulcers can be mistaken for stage II or III pressure ulcers.Although continued unrelieved pressure to the lesions will certainly lead to wound deteriorationregardless of etiology, treatment of herpes must include pharmaceutical management. Becausemedication is critical to healing it is of paramount importance to quickly recognize andtreat herpes. (See Chapter 9: Dermatologic Problems.) To distinguish perianal herpes frompressure ulcers, clinicians should remember that with herpes, there is generally more than onelesion and these lesions are usually distributed bilaterally. Also, herpes ulcers are more painfulthan pressure ulcers of similar depth, and aggressive pain management is often required. (SeeChapter 4: Pain.) Finally, herpes ulcers will not respond to conventional treatment for pressureulcers.CONCLUSION■ Skin care for people with HIV is a critical component of palliative care. Because of the manyfactors contributing to these sometimes debilitating skin disorders it is essential to approachskin care as a team. Physicians, nurses, patients, and caregivers must all work together to providemedical management as well as symptomatic relief.XXVU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 511