Erythema of the proximal nailfold in HIV-infected patients

HIV dermatology in Switzerland--from the beginning to the present

The panendemic of HIV has markedly influenced the dermatology of our generation. This new infection produced atypical manifestations of known dermatological diseases. And beyond that, mucocutaneous diseases emerged, which had not yet been described. Classical epidemiological studies concluded that clustering of AIDS cases could be explained only if AIDS was an infection transmitted by sexual activity or blood. Switzerland was hit early on by the HIV epidemic, and Theo Rufli, the leading expert on sexually transmitted diseases in our country, was involved from the beginning. He contributed with his team to a better delineation of the cutaneous manifestations of HIV infection by directing one of the largest prospective studies on the natural course of cutaneous manifestations of HIV. In addition, he participated in studies which documented new skin diseases in HIV-infected patients. From the very beginning of the epidemic in Switzerland, Theo Rufli founded an organization which helped patients cope with their diagnosis. In Basel, an anonymous consultation facility was established. Theo Rufli also strongly supported the 'Stop AIDS' campaign. This review looks back on the history of HIV in Switzerland and especially in Basel.

Human T lymphotropic virus 1 and hepatitis C virus as risk factors for inflammatory dermatoses in HIV-positive patients

BACKGROUND

Dermatoses are common in HIV-infected patients. Infections caused by human T lymphotropic virus 1 (HTLV-1) and hepatitis C virus (HCV) are also associated with dermatoses, and their coinfection with HIV has been described. The aim of this study was to investigate the influence of HTLV-1 and HCV in increasing the frequency of dermatological diseases in HIV-positive patients.

METHODS

This cross-sectional study included patients infected with HIV and dermatoses, who consulted the Service of Dermatology Outpatient Clinic of the Health Department of the State of Rio Grande do Sul, in southern Brazil. Their care included the taking of a history and a physical examination, complementary examinations for diagnostic purposes, HTLV-1 and HCV serology, measurement of CD4 lymphocyte count and HIV viral load, and recording of the use of antiretroviral drugs.

RESULTS

One hundred and five HIV-positive patients with dermatoses were evaluated. Positivity for HTLV-1 occurred in 12 patients (12.5%) and that for HCV in 35 patients (38%). The most frequently found dermatoses were infectious and inflammatory in origin. A significant statistical association was found between HIV and HTLV-1 coinfection, with dermatoses of inflammatory origin (P = 0.03; CI = 1.14-2.83).

CONCLUSIONS

It is important to consider the high rate of positivity for HTLV-1 and HCV in the HIV-positive patients (12.5 and 38%, respectively). A higher risk of inflammatory dermatoses is found in patients who are simultaneously positive for HTLV-1 and HIV, indicating the possible importance of this coinfection in the development or worsening of certain dermatological diseases.

Painless erythema of the hands associated with non-Hodgkin's lymphoma in a lung transplant recipient

Acral erythema limited to the fingers or the hands has been described in systemic disease. We report the case of a 17-year-old patient who had undergone lung transplantation for cystic fibrosis. Six weeks after transplantation, rapidly growing large-cell immunoblastic non-Hodgkin's lymphoma of the lungs and mediastinum was diagnosed. Sharply demarcated, painless, glovelike erythema was found on both hands. Therapy was reduction of immunosuppression and 12 cycles of extracorporeal photophoresis. After 4 months, lymphoma was in clinical and radiologic remission. Bilateral erythema of the hands also had disappeared. Acral erythema has been reported in association with chemotherapy, collagen vascular disease, infections as with HIV, hepatitis C virus, parvovirus B19, or cytomegalovirus. None of the described associations were detected in this case.