eMedicine Specialties > Dermatology > Viral Infections

Cutaneous Manifestations of HIV Disease: Differential Diagnoses & Workup

Author: Emel Erdal, MD, Associate Professor of Dermatology, Mesa Hospital, Turkey
Coauthor(s): Anna Zalewska, MD, PhD, Assistant Professor, Adjunct Professor, Department of Dermatology and Venereology, Medical University of Lodz, Poland; Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Aug 12, 2009

Differential Diagnoses

Anetoderma
Pityriasis Rubra Pilaris
Aspergillosis
Porphyria Cutanea Tarda
Dermatofibroma
Pyoderma Gangrenosum
Dermatofibrosarcoma Protuberans
Sarcoidosis
Ecthyma
Scabies
Ecthyma Gangrenosum
Sebaceous Carcinoma
Eosinophilic Pustular Folliculitis
Seborrheic Dermatitis
Erythroderma (Generalized Exfoliative Dermatitis)
Sporotrichosis
Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Syphilis
Granuloma Annulare
Viral Infections of the Mouth
Herpes Simplex
Warts, Genital
Kaposi Sarcoma
Warts, Nongenital
Leukoplakia, Oral
Lichen Myxedematosus
Molluscum Contagiosum

Other Problems to Be Considered

Ashy dermatosis
Normolipemic xanthomas
Multiple dermatofibromas
Recurrent neutrophilic eccrine hidradenitis
Pemphigus vegetans
Lichen scrofulosorum
Cutaneous mucinosis
Papulonecrotic tuberculide
Kawasaki disease
Eruptive dysplastic nevi
Dissemination of vaccinia
Ofuji disease
Angiomyolipomas
Glucan-induced keratoderma
Disseminated superficial porokeratosis

Workup

Laboratory Studies

  • Acute primary HIV infection
    • Enzyme-linked immunosorbent assay (ELISA) can be used to screen for HIV infection. Western blot or immunofluorescent assay can be used to confirm the diagnosis.
    • In the asymptomatic period, the patient can be tested for antibodies against p24 and gp41.
    • Symptomatic disease
      • Anti–HIV-1 and anti–HIV-2 can be checked by using ELISA, Western blot, or latex agglutination. HIV may be diagnosed in most patients with the help of ELISA. Western blot assay is expensive, more specific, and can be used as the confirmation test. Latex agglutination, which detects gp120, is rapid and easy to use.
      • Viral load assays can be used to evaluate the effectiveness of the antiviral treatment.
      • Polymerase chain reaction and viral culturing are highly sensitive tests, but they are expensive and technically more difficult to perform.
      • The ratio of CD4+ to CD8+ T cells is decreased.
  • Viral infections associated with HIV infection
    • Direct microscopic examination for HSV infection should be performed. Multinuclear cells with intranuclear inclusions may be present; however, these assays do not distinguish HSV from VZV.
    • Immunofluorescence can be used to detect monoclonal antibodies against HSV-1 and HSV-2.
    • Serology can be used to detect antibodies to type-specific glycoproteins of HSV, VZV, CMV, or EBV.

Imaging Studies

  • Imaging studies may be helpful in evaluating extracutaneous manifestations of KS, lymphoma, and systemic infections.

Other Tests

  • Culturing can be used to detect HIV and HIV-associated opportunistic infections, such as viral, bacterial, atypical mycobacterial, or fungal infections.
  • Electron microscopy can be used to detect HIV-related infections.

Histologic Findings

Histopathologic examination is useful to diagnose cutaneous manifestations of HIV disease with atypical clinical features and KS. Routine hematoxylin and eosin and periodic acid-Schiff stainings may demonstrate multinuclear cells with intracytoplasmic inclusions of HSV infection. Other special stains may identify additional pathogens, or they may confirm malignancies, such as KS.

More on Cutaneous Manifestations of HIV Disease

Overview: Cutaneous Manifestations of HIV Disease
Differential Diagnoses & Workup: Cutaneous Manifestations of HIV Disease
Treatment & Medication: Cutaneous Manifestations of HIV Disease
Follow-up: Cutaneous Manifestations of HIV Disease
Multimedia: Cutaneous Manifestations of HIV Disease
References
[ CLOSE WINDOW ]

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Further Reading

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Keywords

Kaposi sarcoma, Kaposi's sarcoma, KS, human immunodeficiency virus, HIV, HIV-associated malignancy, viral infection, herpes simplex virus, herpes zoster virus, HSV, HZV, Epstein-Barr virus, EBV, cytomegalovirus, CMV, warts, molluscum contagiosum, MC, fungal infections, candidiasis, dermatophytosis, cryptococcosis, histoplasmosis, North American blastomycosis, coccidioidomycosis, bacterial infections, impetigo, folliculitis, bacillary angiomatosis, mycobacterial infections, syphilis, scabies, papulosquamous dermatoses, seborrheic dermatitis, drug eruptions, hair and nail disorders, cutaneous vasculitis, autoimmunity, atopic disease, urticaria, aphthous stomatitis, pruritic papular eruption, PPE, eosinophilic folliculitis, EF

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Contributor Information and Disclosures

Author

Emel Erdal, MD, Associate Professor of Dermatology, Mesa Hospital, Turkey
Disclosure: Nothing to disclose.

Coauthor(s)

Anna Zalewska, MD, PhD, Assistant Professor, Adjunct Professor, Department of Dermatology and Venereology, Medical University of Lodz, Poland
Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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