27th June 2023

Skin infections in HIV

Infection of the skin is more common in HIV than in seronegative people. The most frequent infections include:

Organism	Presentation	Diagnosis/ investigation	Management
Methicillin-resistant Staphylococcus aureus	Usually cellulitis, skin abscesses, or folliculitis.	Clinical presentation or cultures	Incision and drainage, antibiotics including co-trimoxazole, doxycycline and clarithromycin.
Atypical mycobacteria	Often seen as subcutaneous nodules, plaques or ulcers.	Skin biopsy (may demonstrate granuloma)	Combination therapy with rifampicin, ethambutol and a macrolide, as well as surgery if needed
Treponema pallidum (syphilis)	More chancres and slower resolution with red-brown macules, broad distribution, sometimes affecting eyes and oral mucosa.	Skin biopsy, treponemal PCR testing.	Benzathine penicillin G.
Herpes simplex virus	Vesicles, ulcers, verrucous lesions in oral and anogenital regions.	Polymerase chain reaction or direct fluorescent antibody staining	Aciclovir
Varicella zoster virus (VZV)	Most frequently vesicles, bullae or ulcers in a dermatomal fashion	Clinical diagnosis, can use fluorescent antigen testing or PCR	Oral aciclovir, even if >72h from onset – foscarnet if resistant

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