Skin disease in homosexual patients with Acquired Immune Deficiency Syndrome (AIDS) and lesser forms of human T cell Leukaemia Virus (HTLV III) disease

Abstract

Summary The dermatological findings on examination of 13 patients with Aquired Immune Deficiency Syndrome (AIDS) and a further 40 who arc anti‐HTLV III positive without AIDS, are presented. Six of the AIDS patients had Kaposi's sarcoma. Five AIDS patients and eight non‐AIDS patients had seborrhoeic dermatitis. Two AIDS and eight non‐AIDS patients have extensive folliculitis. Biopsy proven immune complex vasculitis developed in two AIDS patients shortly before death. One AIDS patient had acquired ichthyosis and another two developed asteatotic eczema and the fourth‘dry skin’. Fungal infection of the skin, angular cheilitis and a recent history of herpes zoster has also been commonly found. The authors believe that these various manifestations can be explained by low T cell immunity and the effects of severe chronic illness.

Immunology of Diseases Associated withMalasseziaSpecies

“…The higher incidence of Malassezia-associated dermatoses in patients with cellular immunodeficiencies suggests that cellular immunity is also important in maintaining the organism as a commensal. The incidence of PV is known to be increased in renal transplant recipients (228,391) and patients receiving steroids (57); folliculitis is seen in bone marrow transplant recipients (74), and the incidence of SD is very high in patients with AIDS (92,119,141,275,298,408,451). Despite this, only one small study has characterized the cellular immune response to Malassezia at various ages.…”

“…Lesions of SD occur primarily on the eyebrows, nasolabial folds, cheeks, and sternal and interscapular region (337). In the normal population, the incidence of SD is around 1 to 3% (155,352), but in patients who are human immunodeficiency virus positive or have AIDS-related complex or AIDS, the incidence is much higher, ranging from 30 to 83% (92,119,141,275,408), although the incidence of all opportunistic infections has decreased since the widespread use of highly active antiretroviral therapy (323). SD also has a higher than expected incidence in patients with PV (134), Parkinson's disease (55), spinal injuries (471), or depression (266) or those receiving PUVA treatment (434).…”

Etiology and Management of Seborrheic Dermatitis

“…The incidence of this disease is much higher in immunocompromised patients, especially AIDS patients, ranging from 30 to 83% [2, 3]. …”

Fungi on the Skin: Dermatophytes and Malassezia

“…Dandruff is characterized by flaking and pruritis, and it is classified as SD when accompanied by visible redness and extension beyond the scalp to other areas of the face. D/SD is the most common Malassezia-associated dermal disorder, occurring in up to 50% of healthy humans and up to 75% -90% of immunocompromised subjects, especially AIDS patients (Farthing et al 1985;Warner et al 2001). Dandruff has received increased attention because of the following: its common occurrence, its link to loss of self-esteem, its negative social image (Warner et al 2001), and the publication of the dandruff-associated fungal genomes (M. globosa and M. restricta).…”