Skin conditions in HIV for:
- Herpes Zoster
- mild/moderate and severe drug reactions (Steven Johnson Syndrome)
Sent outpatients to dermatology for review. Inpatients will be consulted on the ward.
Blisters, weeping crusts and erosions. Commonly in periorificial areas of the face.
Impetigo is highly contagious. Advise hygiene (washing hands after cleaning crusts and changing and washing clothes, chitenjes, sheets as soon as they are dirty).
Always wash off the crusts with clean water and soap at least twice daily. If mild, treat with GV paint BD making sure to wash off the crusts and GV applied earlier before reapplication. If spreading lesions consider Azithromycine or Flucloxacillin.
Consider presence of underlying skin dermatosis (eg eczema or tinea) that need treatment as well if recurrent or not responding to therapy.
Fungal infection of the skin and hair follicles on the scalp. Spreads via infected combs, brushes or via pets. Present with round patches of hair loss with grayish scaling. The patches may have clear centre with raised margins or contain crusts and pustules.
Treat with Griseofulvin 20-25 mg/kg OD for 6 weeks.
In addition, advise to wash off crusts, pus regularly to minimise inflammation and risk of scarring.
Use Zinc paste in immunocompetent patients which present early.
If severe or immunocompromised use Acyclovir.
Be aware of likely Herpes encephalitis in neonates and immunosuppressed.
Caused by a mite, sarcoptes scabie which burrows and lays eggs under the skin.
Clinical manifestations due to hypersensitivity to the mites, their eggs or their excreta. Ask for history of itch in the family presently or in the last 3 months. Clinical signs include papules, vesicles, burrows and pustules in the web spaces of the fingers and toes, flexor aspects of the wrists, around the umbilicus and genital area. In infants, lesions may also involve palms and soles.
Treatment: BP 25 % is a useful and very effective drug and must be used by the whole family regardless of symptoms. May cause irritation when applied so consider diluting to 12.5 % in children 8 years and below and to 6.25 % in those less than 1.5 years if uncomfortable after applying. Apply overnight and wash off next morning for three consecutive nights. Consider adding Chlorpheniramine Formulary
Secondary Infection with with streptococci is common.