In developing countries, the variations in the clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions over time, and the possible effects of antiretroviral therapy, have not been described. In this study we evaluate the clinical spectrum of oral lesions in a series of HIV-infected patients when first examined at the acquired immunodeficiency syndrome (AIDS) clinic of a tertiary care institution in Mexico City, Mexico, and the changes observed over 12 years. All HIV-infected adult patients had an oral examination performed by specialists in oral pathology and medicine who used established clinical diagnostic criteria for oral lesions. Four periods were defined according to the evolving pattern of antiretroviral use: the first 2 were before the introduction of highly active antiretroviral therapy (HAART) and the last 2 were during more established use of HAART. For the statistical analysis the chi-square test for contingency tables and the chi-square test for trend were utilized. For dimensional variables, except age, the Kruskal-Wallis or Mann-Whitney rank sum tests were used when applicable and trend was tested with the Spearman correlation coefficient. Age was tested through analysis of variance (ANOVA) and linear regression analysis. Alpha value was set at p = 0.05 for each test. In the 12-year study, 1,000 HIV-infected patients were included (87.9% male). At the baseline examination, oral lesions strongly associated with HIV were present in 47.1% of HIV-infected patients. Oral candidosis (31.6%), hairy leukoplakia (22.6%), erythematous candidosis (21.0%), and pseudomembranous candidosis (15.8%) were the most frequent lesions. Oral Kaposi sarcoma (2.3%), HIV-associated periodontal disease (1.7%), and oral non-Hodgkin lymphoma (0.1%) were less frequent. HIV-related oral lesions decreased systematically-by half during the course of the 4 study periods (p < 0.001). Except for Kaposi sarcoma, all oral lesions strongly associated with HIV showed a trend to decrease significantly during the study period. No apparent variation in the occurrence of salivary gland disease or human papillomavirus-associated oral lesions was found. A significant trend to a lower prevalence was observed in the group of patients who were already taking antiretroviral therapy, non-HAART and HAART (p < 0.001 and p = 0.004, respectively). Only a discrete reduction, barely significant, was noted among untreated patients (p = 0.060). By Period IV (1999-2001), those who received HAART showed the lowest prevalence of oral lesions strongly associated with HIV (p < 0.001). Patients with oral lesions strongly associated with HIV had significantly lower median CD4+ counts and higher viral loads than those without oral lesions strongly associated with HIV (p < 0.001 and p = 0.005, respectively). When CD4+ counts were correlated with prevalence of oral candidosis, a consistently negative association was found; this association prevailed even after the study group was partitioned according to period. In this selected cohort of 1,000...

pigment is found as well as moderate fibrosis located deeper in the dermis compared with untreated tattoos. The tannic acid and oxalic acid combination has a better cosmetic outcome than tannic acid alone.Many wavelengths are needed to treat multicoloured tattoos, and not one laser system alone can be used to remove all the available inks and combinations of inks. The composition of tattoo ink varies greatly among like-coloured pigments. This may explain differences in response of seemingly similar tattoo ink to laser treatment in different patients. 4 The popular black ÔgothicÕ style tattoo anecdotally appears more difficult to remove by QS nanosecond lasers. The newer QS picosecond lasers, which appear to be generally more effective, may be the answer to laser-resistant tattoos. 5 Side-effects include hypo-and hyperpigmentation, textural change, and scarring. The latter two effects are more commonly seen with the QS ruby than the QS Nd:YAG laser. When seen, scarring or textural changes are subtle and discrete. 6 The ÔRejuvi Tattoo RemoverÕ technique is being marketed as a safe, simple, cheap, quick and noncolour-selective method of tattoo removal. Only small areas are treated at a time, so the overall cost may not differ greatly from that of a series of standard QS laser treatments. There are no laws regulating this kind of practice and our anecdotal evidence suggests that such a method is not only less effective than laser treatment, but can also result in unacceptable scarring. Tighter regulation and accountability by legislation are needed to protect patients from nonmedical personnel practising cosmetic or medical procedures. References1 van der Velden EM, van der Walle HB, Groote AD. Tattoo removal. tannic acid method of Variot. Int J Dermatol 1993; 32: 376-80. 2 Fogh H, Wulf HC, Poulsen T et al. Tattoo removal by over tattooing. J Dermatol Surg Oncol 1989; 15: 1089-90. 3 Arellano CR, Leopold DA, Shafiroff BB. Tattoo removal: comparative study of six methods in the pig. Plast Reconstr Surg 1982; 70: 699-703. 4 Timko AL, Miller CH, Johnson FB et al. In vitro quantitative analysis of tattoo pigments. Arch Dermatol 2001; 137: 210-2. 5 Ross V, Naseef G, Lin G et al. Comparison of responses of tattoos to picosecond and nanosecond Q switched neodymium: YAG lasers.

Background. Oral lesions may constitute the first clinical manifestation in secondary syphilis, but detailed descriptions in HIV-infected individuals are scarce. Objective. To describe the clinical characteristics of oral secondary syphilis in HIV-infected patients and its relevance in the early diagnosis of syphilis. Methods. Twenty HIV/AIDS adult subjects with oral secondary syphilis lesions presenting at two HIV/AIDS referral centers in Mexico City (2003–2011) are described. An oral examination was performed by specialists in oral pathology and medicine; when possible, a punch biopsy was done, and Warthin-Starry stain and immunohistochemistry were completed. Intraoral herpes virus infection and erythematous candidosis were ruled out by cytological analysis. Diagnosis of oral syphilis was confirmed with positive nontreponemal test (VDRL), and, if possible, fluorescent treponemal antibody test. Results. Twenty male patients (median age 31.5, 21–59 years) with oral secondary syphilis lesions were included. Oral lesions were the first clinical sign of syphilis in 16 (80%) cases. Mucous patch was the most common oral manifestation (17, 85.5%), followed by shallow ulcers (2, 10%) and macular lesions (1, 5%). Conclusions. Due to the recent rise in HIV-syphilis coinfection, dental and medical practitioners should consider secondary syphilis in the differential diagnosis of oral lesions, particularly in HIV-infected patients.

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The importance of the diagnosis of oral conditions in dermatology has been underlined in this study due to the frequency and diversity of oral lesions. The benefits of an interdisciplinary approach in the management of patients has been highlighted.

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A cross‐sectional analysis was conducted in Mexico City from September 1989 to March 1996, to determine the prevalence of HIV‐related oral manifestations by gender and route of HIV transmission. The diagnosis of HIV‐associated oral lesions was based on preestablished criteria. For the statistical analysis chisquared and Fisher's exact tests were used where appropriate. Odds ratios were calculated as estimates of the relative risks. Control of confounding factors was performed by logistic regression models. Oral lesions were present in 75% of 436 HIV+ patients. Hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis and oral ulcers were frequently found. Patients who contracted HIV through blood transfusion were more likely to present erythematous candidosis (P=0.005) than subjects who acquired HIV through sexual transmission. Oral ulcers were seen only in men (P=0.02) and in individuals who contracted HIV through sexual transmission (P=0.02). This study brings valuable data in regard to differences in the type and prevalence of HIV‐related oral lesions by gender and the risk categories analysed, particularly blood transfusion.

We present a case of malignant acanthosis nigricans (AN) that initially manifested in the oral cavity. In the present report, the patient had typical clinical and histological findings of oral and esophageal AN, with subtle skin changes, associated with a gallbladder adenocarcinoma. The importance of the clinical oral examination is emphasized because the recognition of oral lesions led to the diagnosis of AN and to the following detection of the internal malignancy. Since the tumours associated with AN are highly malignant, it is of the utmost importance to recognize the skin and mucous membrane changes in adults.