Cutaneous reaction to ultraviolet irradiation in human-immunodeficiency-virus-infected patients. A case-control study

HIV-associated photodermatitis in African populations

Photosensitive dermatoses are seen in 5% of HIV-infected persons. These include drug- and chemical-induced photoallergic and phototoxic reactions, chronic actinic dermatitis of HIV, photo lichenoid drug eruptions, and porphyria. Data on photodermatitis in HIV are limited to case reports and series. The pathogenesis is not completely understood and includes a th2 phenotype in HIV which results in impaired barrier function and resultant allergen sensitisation as well as immune dysregulation. The objective of this manuscript is to review the literature on the clinical phenotype, pathogenesis, role of photo and patch testing, outcomes, and treatment of photodermatitis in HIV in an African population.

Long-lasting pigmentation more than its intensity is a reliable indicator of skin sun resistance

BACKGROUND

The currently adopted method for predicting sun sensitivity is Fitzpatrick's classification which however is based on self-reported burning tendency and tanning ability.

OBJECTIVE

Determination of the individual UV susceptibility based on non-subjective parameters.

METHOD

Minimal erythema dose (MED), intensity and duration of pigmentation on days 5, 9 and 16 following 1 MED and the levels of the melanin marker pyrrole-2,3,5-tricarboxylic acid (PTCA) were analysed in non-red-haired subjects (50, aged 20-46 years).

RESULTS

Phenotype groups or phototypes showed a good correlation with PTCA yields and the persistence of pigmentation on day 16, but not with MED values. MED values did not show a significant correlation with PTCA yields. On the other hand, high values on day 16 were exhibited only by subjects having PTCA values higher than 200 ng/mg.

CONCLUSIONS

Measurement persistence of pigmentation on day 16 represents a non-invasive and easy-to-perform method to evaluate photoprotection in those individuals escaping straightforward classification based on phenotype or anamnesis.

HIV and skin cancer

AIDS produces profound alterations in normal immunity. Impaired cellular immunity permits new tumor formation as evidenced by the solid-organ transplant literature. The weakened cellular immune system of HIV-infected patients resembles in some ways the iatrogenic immunosuppression in solid-organ transplant recipients. This article summarizes what is known about skin cancer in the solid-organ transplant population and compares the immunodysregulation of HIV infection with the iatrogenic immunosuppression following solid-organ transplantation.

Clinical and epidemiologic characterization of photosensitivity in HIV-positive individuals

BACKGROUND

An increased prevalence and severity of cutaneous photosensitivity has been recognized in association with human immunodeficiency virus (HIV) infection. However, this disorder remains poorly characterized in terms of its epidemiology, predisposing factors, clinical, and environmental associations.

METHODS

To define the risk factors associated with the presence of photosensitivity among HIV-positive individuals, a cross-sectional study of 631 primary patient visits to an urban HIV Dermatology clinic between January 1997 and August 2001, inclusive, was conducted. A multivariate model was fit to estimate adjusted odds ratios for risk factors associated with photosensitivity diagnosis. Subsequently, a case-series of the patients with photosensitivity was reported.

RESULTS

The overall prevalence of photosensitivity was 5.4%, while African-Americans (AA) exhibited a prevalence of 7.3%. In the multivariate model, using highly active anti-retroviral therapy (HAART) (OR=2.82, 95% CI: 1.13, 7.03) and being AA (OR=6.68, 95% CI: 1.56, 28.65) significantly increased the odds of photosensitivity. Patients with photosensitivity were more likely to present during periods of higher ultraviolet (UV) index (P=0.08). Two distinct clinical morphologies were noted: lichenoid and non-lichenoid, eczematous. Sub-morphologies in the non-lichenoid group were suggestive of differences in immunologic profile and estimated UV exposure.

CONCLUSION

Photosensitivity associated with HIV infection is an increasingly recognized dermatologic condition with a heterogeneous clinical presentation. AA ethnicity and HAART were independent indicators for the diagnosis of photosensitivity, whereas CD4+ and UV exposure had non-significant associations. The subtleties in these and other clinical variables may directly aid in the recognition and diagnosis of this poorly characterized disorder.