Papulosquamous dermatoses of AIDS Neil S. Sadick, MD,a N. Scott McNutt, MD,a and Mark H. Kaplan, MDb

New York and Manhasset, New York We review the spectrum of papulosquamous disorders in the setting of infection with the human immunodeficiency virus (HIV). Included is a discussion of xerosis generalisata, seborrheic dermatitis, psoriasis, pityriasis rasea-like eruption, keratoderma blennorrhagicum, acquired ichthyosis, and erythroderma. Mechanisms of pathogenesis, including possible common pathways and relationships to underlying immunosuppression, are emphasized. (J AM ACAD DERMATOL 1990;22:1270-7.)

The human immunodeficiency virus type 1 (HIV1) produces progressive immunodeficiency that results in many opportunistic infections as well as several scaling or papulosquamous cutaneous disorders. I-3 The majority of these infections and proliferative disorders occur as helper T-cell counts fall below 150jmm3•4 These infections are of clinical and prognostic importance because, in addition to being associated with morbidity and discomfort, they also reflect the level of diminished immunocompetence. Scaling dermatoses in HIV-I-infected patients represent a spectrum of mild-to-severe disorders from xerosis generalisata to severe psoriasis and ichthyosis. 5 Persons with this spectrum manifest eruptions resembling seborrheic dermatitis, psoriasis, "persistent" pityriasis rosea, and keratoderma blennorrhagicum. 6-8 The aim of this review is to present the spectrum of papulosquamous disorders occurring in patients with HIV-1 infection. Associations with underlying immunosuppression, possible mechanisms of pathogenesis, and ongoing research investigations also will be presented.

XEROSIS GENERALISATAjASTEATOTIC ECZEMA The most common scaling dermatosis noted in our population of patients with acquired immunoFrom the Department of Medicine (Dermatology), Cornell University Medical College, New York Hospital,- and the Department of Medicine, Cornell University Medical College, North Shore University Hospital. b Reprint requests: Neil S. Sadick, MD, Assistant Clinical Professor of Medicine, Department of Medicine (Dermatology), Cornell University Medical College, 1300 York Ave., New York, NY I002\.

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Fig. 1. Xerosis generalisata. Branny generalized cutaneous asteatosis. deficiency syndrome (AIDS) is a "generalized dry skin syndrome."4 It is often severely pruritic and is refractory to HI antihistaminic therapy. The pruritus may be disproportionate to the degree of clinically obvious xerosis. 9 As noted by Sadick et at} this complex of scaling xerotic skin associated with severe pruritus may be the first clinical manifestation of acquired immunodeficiency syndrome (AIDS). Pruritus with xerosis generalisata has been noted in 4.5% of our AIDS population. 4 The eruption most often presents as fine, diffuse branny scaling (Fig. 1). Occasionally, discrete thickened patches also occur. This disorder occurred with the greatest degree of immunocompetency (i.e., helper T cells

Papulosquamous dermatoses of AIDS.

We review the spectrum of papulosquamous disorders in the setting of infection with the human immunodeficiency virus (HIV). Included is a discussion o...
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