A vast number of skin conditions are possible in someone with HIV/AIDS. From a painless red rash after initial HIV infection to dark purple blotches that signify life-threatening cancer related to AIDS, many different HIV-associated skin conditions are possible. HIV doesn’t always produce symptoms, however, and for this reason, it is important that you be tested if you think you might have been exposed.
Rash and Ulcers of New HIV Infection
A new, or acute, HIV infection does not always produce symptoms, let alone skin symptoms. When symptoms do occur around 2 to 8 weeks after infection, they may resemble mononucleosis, or mono, with fever and extreme tiredness or malaise. During this acute viral illness, skin symptoms may occur, including the following:
-- A red rash: According to "Dermatology," a text by Otto Braun-Falco and colleagues, the appearance of this rash tends to look like other viral rashes rather than specify an HIV infection; it's more commonly found on the trunk than on the limbs and appears as flat red areas with or without small bumps.
-- Less commonly, ulcers on the mouth and genitals may be associated with the new HIV infection.
Warts and Raised Patches
After the initial symptoms of HIV infection disappear, the virus enters a period called latency during which it replicates but causes no major symptoms. This stage of HIV lasts about 10 years unless treatment is received, in which case latency continues indefinitely. With or without treatment, HIV-associated skin conditions may arise, despite the lack of progression to AIDS:
-- The most common is warts caused by the human papillomavirus. Found anywhere on the skin, mucous membranes or genitalia, warts are pale and usually small, although some larger than 1 to 2 cm have been reported.
-- Molluscum contagiosum -- a highly contagious wartlike viral infection -- may actually occur as a result of treatment and recovery of the immune system, as well as in people who are immunocompromised.
-- Skin manifestations of sexually transmitted infections other than HIV are also possible, especially in the genital area.
Other Viral Skin Conditions Associated With HIV/AIDS
In addition to molluscum contagiosum and human papillomavirus, a variety of viruses may attack someone living with more advanced HIV to produce skin symptoms, including the following:
-- Herpes viruses may cause small, painful sores on the mouth or genitals or lead to shingles -- a reactivation of dormant virus -- with a painful, blistering rash that usually appears on one side of the trunk.
-- CMV or cytomegalovirus may emerge when counts of special immune cells called CD4 cells get below 100, with purple spots on the skin and rough warty areas on the trunk, limbs and face.
Bacterial, Fungal and Parasitic Diseases
Staphylococcus aureus is the most common bacterial skin invader in people with HIV, and it causes red bumps, pockets of pus or spreading infections. People living with AIDS are susceptible many more skin infections. Thick, white areas in the mouth are common and can be caused by either a virus or a fungal infection. Itchy conditions include folliculitis, seborrhea and scabies. These conditions can cause small bumps; red, flakey skin; or colonization by mites on the body, face and scalp. Slight raised areas, or plaques and abscesses, or pockets of pus, are also possible due to infections that take advantage of poor immune function.
Kaposi Sarcoma -- An AIDS-Defining Skin Cancer
Once a person's ability to ward off disease is sufficiently compromised, a variety of illnesses may emerge that strongly suggest a diagnosis of AIDS, in and of themselves, in appropriate individuals. One such disease is Kaposi sarcoma, a cancer common in people with weakened immune systems. Symptoms include dark red, purple or brown patches of skin on the body or inside the mouth or nose that may be confused with bruises at first. Outgrowths and tumors may also occur.
- American Academy of Family Physicians: Diagnosis and Initial Management of Acute HIV Infection
- American Academy of Family Physicians: How to Recognize and Treat Acute HIV Syndrome
- Johns Hopkins Medicine: HIV/AIDS and Skin Conditions
- Physicians Research Network: Common Cutaneous Complications of HIV Disease
- University of Maryland Medical Center: Photodermatitis
- Dermatology; Otto Braun-Falco, et al.
- Microbiology and Immunology; Monica Gandhi et al.
- Skin Diseases in the Immunocompromised; John C. Hall