27th June 2023

Skin conditions in HIV

HIV causes skin disease chiefly through the dysfunction of immune cells usually active in the skin which ordinarily reduce skin disease. In addition to loss of CD4+ T-cells, HIV causes:

• Fewer Langerhans cells
• Fewer macrocytes and monocytes
• Fewer NK cells

This causes fewer antigens to be presented, resulting in a range of skin conditions:

• Xerosis results from problems in the microcirculation leading to loss of oils in the skin and dryness, and is very common in HIV
• Atrophic dermatitis – common in the population but more frequent in persons with HIV
• Psoriasis – this is more frequent and has a different pattern than in seronegative individuals, with more extensive lesions, more frequent psoriatic arthritis and more acral lesions (affecting the hands and feet) than in seronegative individuals. An inverse pattern (affecting skin folds) is also more commonly seen.