                   AIDS INFORMATION NEWSLETTER
                   Michael Howe, MSLS, Editor
                     AIDS Information Center
                VA Medical Center, San Francisco
                     (415) 221-4810 ext 3305
                         August 25, 1995

               Opportunistic Infections (Part VII)
                           Dermatitis

                 Skin Problems and HIV Infection
         Margaret E. Muldrow, MD and Kees Rietmeijer, MD

BEING ALIVE; Published by BEING ALIVE / Los Angeles April 1995

     Dermatology is a visual specialty. Dermatology is also about
touching people-touching their skin to make a diagnosis. Before
asking a lot of questions about a particular rash or lesion,
dermatologists must look closely and describe for themselves what
they see. It is only then that a diagnosis can be made and a
treatment plan developed.
     Almost everyone knows that opportunistic infections in people
infected with HIV become more prevalent as CD4 counts fall.  This
is also true of skin problems in patients with HIV. In fact, almost
100% of all patients with CD4 counts less than 200 will have some
sort of dermatologic condition. Although dermatologic conditions
like dry skin, seborrheic dermatitis and scabies are not
life-threatening diseases (like pneumocystis pneumonia or
cryptococcal meningitis), these disorders impact greatly on the
quality of life of someone with HIV. It is not uncommon for a
dermatologist to be referred a patient who is taking ten different
kinds of medications, who has disseminated MAC and is going blind
from CMV, who tells us that they can live with all of that, but the
thing that is driving them "crazy" is this terrible itch.
     This tells us something about the patient's quality of life.
And the good news is that dermatologists can have a positive impact
on a person's quality of life by alleviating some of their symptoms
and possibly even curing some of their skin problems.
     The following is a quick review of a wide range of
dermatologic manifestations seen in patients with HIV infections
along with the standard treatment. As with all medical treatments,
working with your physician is essential because not all people or
viruses, bacteria or fungi respond exactly the same every time. 

Rash of Seroconversion

     Individuals who are in the process of seroconverting to being 
HIV+ may develop a fever, malaise, muscle and bone pain, a sore
throat, enlarged lymph nodes and even a rash. This rash, which can
be described as faint background redness that is distributed
primarily over the trunk, is easily missed and lasts only a short
period of time. 

Herpes Simplex 

     The most common skin problems associated with HIV infection
are viral in nature. As people become sicker, herpes infections
tend to become recurrent, persistent and even widely disseminated.
In clinic, dermatologists often see many individuals with perianal
herpes. Acyclovir usually clears up the problem in seven to ten
days. If the lesions persist, it is often a sign that there is
associated infection with bacteria, fungus or even another type of
virus. Foscarnet, although a toxic and poorly tolerated medication,
can be used for acyclovir resistant strains of herpes.

Herpes Zoster

     In 1982, Dr. Rietmeijer began working at one of the sexually
transmitted disease clinics in Amsterdam. At that time, AIDS was
perceived as something that was very far away from Amsterdam. It
was across the ocean. Nobody thought they would ever have a problem
with it there, but by the middle of that year, they began to see
more and more gay men with herpes zoster or "shingles." In
retrospect, 12 years later, it is obvious that these individuals
were infected with HIV and that "shingles" was the first
manifestation of their illness.
     "Shingles" is produced by the same virus that causes chicken
pox. Although the chicken pox rash may go away, the individual
remains infected with the virus which hides out in the nervous
system. As people become sicker and their immune systems become
more compromised, the virus is reactivated producing painful
blisters along the distribution of a nerve.  "Shingles" is treated
with acyclovir, but in doses four times that used for the treatment
of herpes simplex. 
 
Human Papilloma Virus (HPV)

     This virus produces warts which can occur anywhere on the  
body including the genitals, anus, mouth, hands, arms and feet. The
lesions are often extensive and very hard to treat. Liquid nitrogen
and podophylline are the main forms of therapy.

Molluscum Contagiosum

     This is an infection produced by a pox virus. Lesions are
described as firm, flesh colored bumps with a central depression
which tend to occur on the scalp, face and genital area. They can
be very extensive and disfiguring. Treatment is similar to that
used for warts.

Fungal Infections

     "Ringworm" and "athlete's foot" are common in patients
infected with HIV and can be treated with topical or oral
antifungal therapy. Although rare, cryptococcus can involve the
skin. Lesions are often mistaken for molluscum. This infection can
be life threatening and is more difficult to treat.

Bacterial Infections

     Impetigo, recurrent "boils" and microbacterial infections are
also seen. Basilary angiomatosis, which is caused by the "cat
scratch" organism, has been described only in HIV+ patients. We
have not seen a case of this in Denver. These infections are all
treated with antibiotics.

Scabies

     Infection is caused by a mite which burrows into the upper
layers of the skin where it lives and lays its eggs. The body's
immune response to the mite produces a very itchy rash. Treatment
involves the use of Kwell or Permethrim lotion and close followup.

Seborrheic Dermatitis

     More commonly known as "dandruff," this disorder is
characterized by yellow to white scale on the scalp. In people
infected with HIV, the lesions can also become more extensive (also
involving the central face and chest) and more severe. It may also
be an initial sign of HIV infection. Treatment includes the use of
an anti-dandruff shampoo, topical steroid ointments and
antifungals.

Psoriasis

     One to three percent of people with AIDS develop psoriasis.
This is a disorder characterized by red bumps and plaques with
thick silvery white scale that are most commonly found on the
scalp, trunk, elbows, knees and buttocks. It is not an infectious
process, but all kinds of infections can make it much worse.
Unfortunately, the disorder can become severe (even requiring
hospitalization) and is often very difficult to treat.

Eosinophilic Folliculitis

     Nearly all individuals with CD4 counts below 100 will at some
time in the course of their illness suffer from severe itching. One
disorder that often causes this symptom is eosinophilic
folliculitis (commonly called "itchy bump syndrome"). Patients
develop very itchy red bumps around the hair follicles on their
neck, upper trunk and arms. Since the cause of the disorder is
unknown, treatment is empiric with the use of itraconazole and
indocin along with good basic skin care.

Dry Skin

     This is a problem for people living in Colorado where the
climate is dry, but in particular, for people infected with HIV.
Treatment involves taking fewer showers or baths and the use of
lots of moisturizers and topical steroids.

Drug Reactions

     Reactions to medications are more common in people who are
HIV+ than in the general population and reactions become more
frequent as the disease progresses. Bactrim and penicillin cause
the most reactions, but people with central nervous system
toxoplasmosis who are taking anti-seizure medications appear to be
at high risk for the most serious kinds of drug reactions. 

     (This article was excerpted from the presentation given by 
Margaret F. Muldrow, MD and Kees Rietmeijer, MD at the 10th Annual
Rocky Mountain Regional Conference on HIV Disease held February
2-4, 1995 in Denver, CO and is reprinted from the April 1995 issue
of Resolute!) 
 
     Copyright (c) 1995 - BEING ALIVE/Los Angeles.  Distributed by
AEGIS, your online gateway to a world of people, information, and
resources.  714.248.2836 * 8N1/Full Duplex * v.34 


                     ======================
                    Project Inform Fact Sheet
                     ======================

                   Dermatologic Manifestations
  
[Reprinted from: STEP PERSPECTIVE, Vol. 2, No. 4, June 1992, pages
16-17,30]

Skin Manifestations Related to HIV 
by Laury McKean, R.N. 
 
FOR YEARS, TELEVISION ADVERTISING has been selling remedies for
skin problems by talking about the 'heartbreak of psoriasis', and
the social consequences of dandruff.  However, afflictions of the
skin, nails, and hair are a serious concern for HIV-infected
people.  They occur in up to 90% of people with AIDS, and often
people suffer from two or more skin related disorders at one time. 
This article discusses the most commonly seen skin conditions and
ways to treat them. 
 
SEBORRHEIC DERMATITIS 
 
Seborrheic dermatitis is extremely common in people with HIV.  It
is more commonly known as dandruff when it affects the scalp.  It
is also commonly found on the face (especially around the
eyebrows), chest, back, groin and armpits.  The affected area is
usually red with a yellowish, greasy scale.  When the lesions are
limited to the face, they are usually asymptomatic, but when other
areas are affected, it can cause itching.  Seborrheic dermatitis
may be caused by a fungus, Pityrosporum ovale.  Treatment for the
scalp includes regular use of dandruff shampoos containing selenium
sulfide (selsun), zinc pyrithione (Head & Shoulders, Danex,
Zincon),or sulfur and salicylic acid (Vanseb, Sebulex).  A
medium-potency steroid solution, such as triamcinolone 0.1 %, may
be added to the treatment regimen if the shampoos don't control it.

For lesions on the face and other parts of the body, ketoconazole
cream, sometimes in combination with hydrocortisone cream applied
twice daily is usually effective.  For severe cases, a 2 to 4 week
course of oral ketoconazole, 200) to 400 mg daily, may be of
benefit. 
 
Individuals who have recurrent episodes of seborrheic dermatitis
may benefit from using dandruff shampoo as an all over body wash
to prevent the episodes. 
 
PSORIASIS 
 
Psoriasis often occurs as a new disease after HIV infection. 
Individuals with preexisting psoriasis who become infected with HIV
may experience a more severe form.  The initial lesions often begin
like seborrheic dermatitis, but usually spread to the armpits and
groin, then to the elbows, knees, and lower back.  Psoriasis
lesions in the armpits and groin look identical to seborrheic
dermatitis, but when psoriasis involves the trunk, it tends to be
more fixed and with thicker scales.  Psoriatic arthritis occurs
more often in people with HIV than those who are HIV negative. 
Mild to moderate psoriasis usually responds well to topical
corticosteroids, anthralin, or tar.  Wide spread disease is more
difficult to treat, but significant improvement is often seen using
AZT at higher doses.  With a dosage of 200 mg every 4 hours of AZT,
relief of itching can occur within a week and partial or even
complete clearing can be seen within 6 to 8 weeks.  However, when
the dose is reduced or stopped, the psoriasis recurs.  Phototherapy
(exposure to various concentrated light rays) has also been used
effectively in severe cases, however this therapy could be
immunosuppressive. 
 
HERPES SIMPLEX VIRUS 
 
The majority of herpes infections in people with HIV are due to
reactivation of the latent virus.  The most common sites of the
herpes outbreaks are, in order of frequency, perianal, genital,
around the mouth and oral cavity, and the fingers.  The lesions
typically begin as a small cluster of blisters on top of a reddened
area and then form shallow ulcers or crusted lesions as they are
healing.  These lesions will often heal within one to two weeks
without treatment.  However, as immune deficiency progresses, these
lesions can become more progressive an persistent, requiring prompt
treatment. @o Herpes outbreaks in early HIV infection often respond
well to topical acyclovir cream.  If this fails, oral acyclovir at
a dose of 200 mg 5 times a day is usually effective.  For extensive
infections, intravenous acyclovir can be used.  Acyclovir-resistant
strains of the virus can occur and may respond to treatment with
intravenous foscarnet or vidarabine. 
 
Because the herpes virus contributes to immune suppression, many
physicians now prescribe oral acyclovir, 400 mg twice a day, to
individuals who have problems with recurrent herpes outbreaks as
a prophylaxis to prevent the outbreaks from occurring and further
suppressing the immune system.  Some believe this practice will
increase the chances of developing acyclovir-resistant strains, But
physicians who use prophylactic acyclovir therapy claim they see
less resistant strains in patients who are using daily prophylactic
acyclovir than in patients who only receive acyclovir as a
treatment for a herpes outbreak.
 
HERPES ZOSTER 
 
Herpes Zoster or "shingles" is caused by the varicella zoster virus
(VZV), which is a member of the herpes virus family.  This virus
lies dormant in the body after a person has had an outbreak of
chickenpox and can become reactivated when immune suppression
occurs.  Herpes zoster is seven times more common in people with
HIV than HIV negative individuals.  It can occur early in the
course of HIV infection as well as late.  The initial symptom of
herpes zoster is the sensation of pain (may require a pain relief
drug), burning or tingling in one area of the body that is very
tender if touched or if clothing rubs against it.  A red rash of
small, fluid-filled blisters will appear usually in a distinct
pattern, and the pain will increase.  The rash correlates with the
location of the infected dermatome (nerve), most commonly around
one side of the torso.  In people with HIV, more than one dermatome
can be infected at the same time, including the face, eyes, and
mouth.  The blisters generally begin to crust over and heal within
two weeks, but often high-dose acyclovir must be used as treatment.
Intravenous acyclovir may be necessary in severe or widespread
cases, especially those involving the eye.  Acyclovir resistant
strains of herpes zoster can also occur.  These strains appear to
be sensitive to vidarabine or foscarnet.  There are some topical
creams, Axsain and Zostrix, which may help decrease pain which
persists after the blisters are gone. 
 
MOLLUSCUM CONTAGIOSUM 
 
Molluscum contagiosum is a viral infection which occurs in 10 to
20% of people with symptomatic HIV disease.  The lesions can appear
anywhere, but are most commonly found on the face (especially the
eyelids), genital area, and buttocks.  They appear as raised,
flesh-colored, centrally indented bumps with a pearly border and
can number from one to hundreds.  The lesions can be spread easily
by shaving or scratching.  This spreading may be reduced by shaving
the infected facial areas last with a disposable razor, and by
refraining from scratching them.  Treatment Of molluscum
contagiosum can be difficult.  The most common methods are
cryotherapy (freezing) with liquid nitrogen, removal with a sharp
instrument, or light electrocautery.  Therapy with AZT has also
been reported to be effective in some cases.  Retinoic acid (Retin
A) cream has been used to slow down the appearance of new lesions,
but does little to help lesions that are already present and can't
be used on the eyelids or genitals.   A clinical trial of alpha
interferon for treatment of molluscum contagiosum is under-way. 

HUMAN PAPILLOMAVIRUS (HPV) 
 
Human papillomavirus is the virus that causes warts which are seen
with increased frequency in people with HIV.  In most cases they
appear as regular or flat warts, but are often seen in multiple
numbers in people with HIV and can be more difficult to treat. 
Genital warts can be particularly troublesome.  Therapy can include
cryotherapy, electrocautery, excision, or injections of alpha
interferon directly into the lesion.  Because genital warts can
lead to Cancer, treatments should be discussed with your physician.

XERODERMA 
 
Xeroderma, better known as dry skin, occurs in 23 to 30% of HIV
infected individuals.  It appears as a flat, slightly scaly rash
which comes and goes.  It can occur anywhere on the body, but is
most commonly found on the front of the lower legs.  The cause of
this is unknown.  There does not appear to be any correlation with
the degree of immunosuppression, suggesting it may be directly
related to HIV.  Other possible causes include malnutrition, long
standing illness, poor hygiene, or immunologic deficit.  The use
of bath oils, lotions, and Dove soap may be beneficial.  Also,
decreasing the frequency of bathing and lowering the temperature
of the water may help. 
 
FOLLICULITIS 
 
Folliculitis appears as red pustules around hair follicles that can
itch severely.  It can be seen anywhere, but is often found on the
trunk.  Folliculitis is often caused by the bacteria
staphylococcus, which responds well to treatment with antibiotics
such as dicloxacillin, in about 7 to I 0 days.  Eosinophilic
folliculitis can also occur.  The cause of this extremely itchy
rash is unknown, but it usually is controlled by ultraviolet light
treatment.  It can also be caused by a fungus, Pityrosporum.  This
type of folliculitis usually occurs on the upper trunk and arms. 
It responds well to ketoconazole treatment.

BACILLARY ANGIOMATOSIS 
 
Bacillary angiomatosis is a newly described infection that is
rarely seen in non HIV infected individuals.  It appears as papules
or nodules that are usually purplish to bright red and often
resemble Kaposi's sarcoma.  The lesions are firm and non blanching 
(they do not turn white when you push on them).  They can occur
anywhere on the body in numbers ranging from one to hundreds but
are rarely seen on the palms, soles, or in the mouth.  High fever
is usually present and the infection can spread to the bone, bone
marrow, spleen, lymph nodes and liver. It can be easily treated
with antibiotics such as erythromycin and doxycycline.  Treatment
is given until the lesions resolve, usually in 3 to 4 weeks.  In
some people, the lesions can regress without treatment. 
 
PHOTODERMATITIS 
 
Photodermatitis is the eruption of itchy, thick, scaly patches on
portions of the skin that are commonly exposed to the sun.  It can
also resemble a bad sunburn.  These areas can also turn lighter in
color than the rest of the skin.  Photodermatitis is rarely caused
by HIV disease, but certain medications that people with HIV
commonly take such as sulfa drugs, hypericin, and nonsteroidal
anti-inflammatory drugs predispose people to hypersensitivity to
the sun.  This condition can be managed with relative case if it
is recognized, but if the condition is ignored can worsen and will
not respond as easily.  Photodermatitis is managed by
discontinuing, if possible, any medications that may be
contributing to the condition, avoiding exposure to the sun with
clothing, hats, and sunblocks, and applying medium to high-potency
steroid creams to the lesions. 
 
INSECT BITE REACTIONS 
 
People with HIV often have exaggerated responses to insect bites
including mites, fleas, mosquitoes, and spiders.  Often the
location of the eruption will give clues as to what the offending
insect is.  When lesions and itching occur between the fingers,
feet, armpits, or genitals, scabies mites should be suspected.  As
immunodeficiency progresses, HIV  infected people are more apt to
experience crusted (Norwegian) scabies, in which the number of
scabies can be in the millions.  Treatment with gamma benzene
hexachloride or permethrin lotion is usually effective, although
in crusted scabies, lotion may need to be applied to the entire
body.  Demodicidosis, caused by demodex mites, causes an itchy
eruption most commonly occurring on the scalp, face, and neck. 
These mites usually respond well to the same treatment as the
scabies mites.  The itching caused by mosquitoes, fleas, and spider
bites can be unrelenting.  These can best be managed by 1)
attempting to eliminate the insects from your environment with 
insecticides, 2) making your body less attractive to insects with
insect repellents containing diethyl toluamide and 3) blocking the
reaction to the bite with regular doses of antihistamines. 
 
DRUG REACTIONS 
 
People with HIV are at increased risk for developing allergic
reactions to medications.  Also, some underlying opportunistic
infections such as cytomegalovirus or Epstein Barr virus in people
with HIV may predispose them to adverse drug reactions.  As many
as 70% of people with HIV develop adverse reactions to Bactrim
(Septra) which is commonly prescribed as prophylaxis for
Pneumocystis carinii pneumonia.  The most common symptom of adverse
drug reactions is a widespread red rash across the back, chest,
arms, and legs, and occasionally involving the face and mucous
membranes.  The rash can be flat, resembling a sunburn, or with red
raised bumps.  Although any drug can cause this type of reactions,
the most common ones are antibiotics, such as penicillin's and
sulfa drugs.  The reactions will resolve when the offending, drug
is removed.  Antihistamines, H1 or H2 blockers, or steroids are
sometimes used to help block the reaction.  Occasionally, people
can be desensitized to drugs which have previously caused adverse
reactions.  Desensitization is achieved by administering small
amounts of the drug, gradually increasing the dosage over a period
of time.  Desensitization should only be attempted under the close
supervision of your physician. 
 
AZT can cause hyperpigmentation of the skin and mucous membranes,
although it only appears to affect the mucous membranes in black
people.  Foscarnet has induced painful ulceration's of the penis
in some individuals receiving high doses.  These ulcers resolved
spontaneously in all and without discontinuing treatment in about
50%. 
 
NAIL DISORDERS 
 
Yellow discoloration of the nails has been seen frequently in
people with Pneumocystis carinii pneumonia.  Fungal infections can
also cause yellowing of the nails as well as thickening.  Because
the nails are difficult to penetrate with antifungals and because
nails take a long time to grow, fungal infections of the nails are
extremely difficult to treat.  AZT can cause blue to brown-black
discoloration of the nails, more so in those individuals receiving
higher doses.  The discoloration usually starts about 4 to 8 weeks
after beginning AZT.  Longitudinal streaks on the thumbnails are
the most common. 
 
HAIR CHANGES 
 
People with HIV often develop thinning of scalp as well as body
hair for  unknown reasons.  This thinning can be worsened if
seborrheic dermatitis is present.  Sudden premature graying is also
seen more frequently with HIV, probably as a result of
malnutrition.  Other hair changes seen more frequently in people
with HIV are hypertrichosis of the eyelashes, and alopecia
(balding).  In addition, lengthening, lightening color, and
softening of the hair can occur in black people. 
 
Effective treatments are available for many of the conditions
described above, and results are particularity good when the
problem is diagnosed and treated as early as possible.  Early
treatment also increases a person's comfort, well being, and
physical appearance.  If you or someone you care for is leaving
skin problems, do not hesitate to consult a dermatologist who is
experienced in treating HIV related conditions. 


----------------------------------------------------------------- 
CHART: Skin Manifestations Associated with HIV Infection 


Seborrheic Dermatitis 
---------------------- 
 
CONDITION: Appears as dandruff when the scalp is affected.  Other
areas develop red patches which may itch and have a greasy,
yellowish scale. 
 
LOCATION: Usually affects the scalp, face (especially the eyebrows
and sides of the nose), chest, back, groin, and armpits. 
 
TREATMENT: Dandruff shampoo, ketoconazole cream 2%, sometimes in
combination with hydrocortisone 2.5% creams applied twice a day.
For severe cases 200-400 mg oral  ketoconazole a day may be
necessary. 
 
DURATION OF TREATMENT: Until lesions resolve  Oral ketoconazole:
2-4 weeks.  Prophylactic use of dandruff shampoo as a body wash may
be effective in individuals with recurrent episodes. 
 
 
Psoriasis 
---------- 

SYMPTOMS: Appears similar to seborrheic dermatitis but more fixed
with thick scales and a silver tinge. 
 
LOCATION: Commonly appears in areas such as armpits, groin, elbows,
knees, and the lower back. 
 
TREATMENTS: Mild to moderate: topical corticosteroids, anthralin,
or tar Widespread: 200 mg AZT every 4 hours 
Severe: phototherapy 
 
DURATION OF TREATMENT: Indefinitely 
 
 
Herpes Simplex Virus 
--------------------- 
 
CONDITION: Appears as small clusters of blisters on top of a
reddened area, progressing to shallow ulcers, that form crusted
lesions as they are healing.  The lesions usually heal without
scaring. 
 
LOCATION: Lesions occur most commonly in the following order:
perianal, genital, face, finger. 
 
TREATMENT:  
Mild: acyclovir cream 
Moderate: 200 mg oral acyclovir 5 times a day. 
Severe: intravenous acyclovir. 
Prophylaxis: 400 mg acyclovir 
twice a day 

DURATION OF TREATMENT: 7 - 10 days or until healed with no new
lesions for 3 days

Indefinitely 
 
 
Herpes Zoster (Shingles) 
-------------------------- 
 
SYMPTOMS: Usually begins with the sensation of pain, burning, or
tingling, followed by a red rash of small blisters which follow the
dermatome (nerve) in a distinct pattern. 
 
LOCATION: Most commonly appears around one side of the torso, but
can be found along any dermatome line, including the face.  It can
affect more than one dermatome at a time. 
 
TREATMENT: Mild to Moderate: 800 mg oral acyclovir 5 times a day.
Severe (involving one or more dermatome or the eye): 10 mg/kg 
intravenous acyclovir every 8 hours. 
Symptom relief: Axsain or Zostrix cream applied to intact skin. 
 
DURATION OF TREATMENT: 7 to 10 days 
Until no new blisters for 3 days, then switch to oral acyclovir. 
 
As needed. 
 
 
Molluscum Contagiosum 
---------------------- 
 
SYMPTOMS: Appear as raised, flesh-colored bumps with a pearly
border which are indented in the middle. 
 
LOCATION: Most commonly found on the face (especially the eyelids),

genital area, and buttocks. 
 
TREATMENT: Retin A cream or AZT may be effective in some cases. 
Cryotherapy (freezing), electrocautery, or excision can be used for
severe cases or cosmetic reasons. 
As necessary 
 
DURATION OF TREATMENT: Repeat every 2 to 3 weeks until resolved.


Human Papillomavirus (HPV) 
--------------------------- 
 
SYMPTOMS: Usually appear as regular or flat warts often in multiple
numbers 
 
LOCATION: They commonly appear in the anogenital area, but can be
found anywhere on the body. 

TREATMENT: Cryotherapy, electrocautery, excision, or other
destructive techniques. 
 
DURATION OF TREATMENT: Anogenital: injections of alpha interferon
directly into the lesion. Repeatedly until resolved. 
 
 
Bacillary Angiomatosis 
------------------------ 
 
SYMPTOMS: Appear as purplish to red spots which are firm and do not
turn white when pressure is applied,  The lesions often resemble
Kaposis Sarcoma, but a fever or general malaise is usually present.

LOCATION: The lesions can occur anywhere on the body, but rarely
on the palms, soles, or int the mouth.  It can spread to the bone,
bone marrow, spleen, lymph nodes, and liver. 
 
TREATMENT: 500 mg erythromycin 4 times a day or 100 mg Doxycycline
2 times as day. 
 
DURATION OF TREATMENT: 2 - 3 weeks for skin lesions.  If the
infection has spread in internal organs or bone, treat for at least
six weeks. 
 
 
Photodermatitis 
---------------- 
 
SYMPTOMS: Usually appears as itchy, scaly patches or it may
resemble a bad sunburn.  The affected areas my turn lighter in
color than the unaffected skin 
 
LOCATION: Occurs on portions of the skin that are frequently
exposed to the sun, such as the neckline. 
 
TREATMENT: Protection from the sun using clothing and/or
sunscreens.  Topical or systemic steroids may be used for severe
cases. Discontinue photosensitizing drugs if possible. 
 
DURATION OF TREATMENT: Continuously during sunny weather. As
needed. 
 
 
Staphylococcal Folliculitis 
---------------------------- 
 
SYMPTOMS: Appears as small red bumps around hair follicles which
may resemble pimples, but itch severely. 
 
LOCATION: Most commonly found on the face, groin, and trunk 
 
TREATMENT: Mild to moderate: 500 mg dicloxacillin 4 times a day.
Severe: add 600 mg rifampin a day to the dicloxacillin. 

DURATION OF TREATMENT: dicloxacillin: 7 - 10 days, rifampin: 5 days

 
Eosinophilic Folliculitis 
-------------------------- 
 
SYMPTOMS: Appears as small red bumps around hair follicles which
may resemble pimples, but itch severely. 
 
LOCATION: Most commonly found on the trunk and face 
 
TREATMENT: Ultraviolet light treatments performed by a
dermatologist. 
 
DURATION OF TREATMENT: As needed. 
 
 
Fungal Folliculitis 
-------------------- 
 
SYMPTOMS: Appears as small red bumps around hair follicles which
may resemble pimples, but itch severely. 
 
LOCATION: Commonly appears on the upper trunk and arms. 
 
TREATMENT: 200 to 400 mg oral ketoconazole. 
 
DURATION OF TREATMENT: 10 to 14 days 
 
 
Xeroderma (Dry Skin) 
-------------------- 
 
SYMPTOMS: Generally appears as a scattered, flat slightly scaly
rash which comes and goes sporadically. 
 
LOCATION: Can occur anywhere on the body but is most commonly found
on the front of the lower legs. 
 
TREATMENT: Bath oils, moisturizing lotions, Dove soap, and
decreasing the frequency of bathing and the temperature of the
water may be beneficial. 
 
DURATION OF TREATMENT: As needed. 
 
 
Drug Reactions 
---------------- 
 
SYMPTOMS: Commonly appears as a widespread red rash which may be
flat (resembling a sunburn) or with raised bumps. 
 
LOCATION: Usually appears across the back, chest, arms, and legs,
and sometimes involves the face. 

TREATMENT: Discontinue the drug which caused the reaction if
possible.  Antihistamines, steroids, H1 or H2 blockers may be
helpful. 
 
DURATION OF TREATMENT: As long as needed. Steroids should be used
for no more than 4 weeks. 
 
 
Kaposi's Sarcoma (KS) 
---------------------- 
 
SYMPTOMS: The lesions my be red, purple, blue or black.  They are
generally flat, painless and do not ich or drain.  They look
similar to a bruise, but do not blanche when pressure is applied. 
They may become elevated, patch-like, and flow together as they
progress. 
 
LOCATION: The lesions can occur anywhere on the body, but the most
common sites in one large study were as follows: 52% trunk, 45%
legs, 40% oral cavity, 38% arms, 33% Face.  The lesions can also
involve the gastrointestinal tract, lungs, lymph system, and other
internal organs. 
 
TREATMENT: Localized lesions: radiation therapy, injections of
alpha interferon directly into the lesions, or Retin-A.  Widespread
lesions: chemotherapy or subcutaneous alpha interferon.: 
 
DURATION OF TREATMENT: Until lesions resolve. 
 
 
Insect Bite Reactions 
----------------------- 
 
SYMPTOMS: Appear as either single or multiple red, raised bumps
which may itch intensely 
 
LOCATION:  
Scabies mites: between the fingers, feet, armpits, or genitals 
Demodex mites:  scalp, face, and neck.  
Fleas: most commonly affect the lower legs.   
Mosquitoes: most commonly affect the arms and legs. 
 
TREATMENT: Gamma benzene hexachloride or permethrin lotion.  
DURATION OF TREATMENT: Once a week for two weeks. 
 
Antihistamines, insect repellents, insecticides. 
DURATION OF TREATMENT: As needed. 
 

================================================================= 

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call Project Inform. 
 
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publications is accurate. We encourage you to check out the
publications from which this information is taken; a resource list
is available form Project Inform's Hotline. 
 
Copyright- San Francisco Project Inform, 1994 
 
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