A study of clinicopathological correlation of pruritic papular eruptions in HIV patients

Abstract

Context:Pruritic papular eruption (PPE) is a chronic eruption of papular and pruritic lesions of unknown etiology, symmetrically distributed over trunk and extremities. These are common cutaneous manifestations in HIV patients. It is an important cause of HIV-related morbidity. PPE can be the first marker of HIV. Their etiology, histopathological findings, and associated factors vary from region to region. There are no clear data available on the etiology, exact spectrum of the condition, histopathological findings, or treatment of PPE.Aims:The study is aimed at documenting the etiology, CD4 count, and its histopathological correlation in HIV-infected patients.Settings and Design:An observational study conducted in Government Medical College, Patiala.Subjects and Methods:Two-year data regarding history, HIV status, cluster of differentiation 4 (CD4) cell count, and skin biopsy of clinically suspected PPE patients with known HIV status were analyzed.Statistical Analysis Used:All the results were then statistically analyzed. Categorical data were analyzed by Chi-square test, and one-way Spearman's rho test was used for multiple group comparison.Results:Data of 50 eligible patients were analyzed. The majority of the patients were female (between 21 and 50 years of age). The most common histopathological patterns were of papular urticaria, scabies, and drug reaction, and the others less common PPE were polymorphic light eruption and eosinophilic folliculitis. Patients with papular urticaria (32%) had significantly lower mean CD4 counts (157 cells/mm3), while in scabies, the mean CD4 count (376 cells/mm3) was higher.Conclusions:We conclude that histopathology helps in specifying the pattern of PPE and its etiology. It can be a marker of advanced HIV infection. Thus, correlation between the histopathology, clinical diagnosis, and CD4 counts helps to know the disease process.

Karakteristik Penyakit Kulit dan Kelamin pada Penderita Infeksi Human Immunodeficiency Virus di Rumah Sakit Umum Daerah Buleleng

“…Etiopatogenesis penyakit ini belum diketahui dengan jelas, namun diduga akibat reaksi hipersensitivitas terhadap gigitan arthropoda. Biasanya muncul dengan lesi papular dengan ekskoriasi multipel, diskrit, gatal dan pigmentasi pasca inflamasi yang terletak di permukaan ekstensor ekstremitas, badan dan wajah (Chopra et al, 2018). Pigmentasi pascainflamasi, nodul dan jaringan parut seperti prurigo dapat berkembang sekunder akibat eksoriasi ekstensif karena gatal yang parah.…”