Skin changes are common for people living with HIV, though these manifestations are highly variable and often resemble conditions seen in the general population. Approximately 90 percent of individuals with HIV develop some form of skin symptom during the course of their disease. No single skin rash or bump exclusively indicates HIV infection. This article describes various skin manifestations that can occur with HIV. However, this information is not intended for self-diagnosis; any concerns about skin changes or possible HIV exposure should always prompt consultation with a healthcare professional for accurate diagnosis and appropriate medical guidance.
Skin Manifestations in Early HIV Infection
During the acute phase of HIV infection, often referred to as acute retroviral syndrome, a characteristic skin rash can develop. This rash typically appears within two months of contracting the virus, sometimes as early as a few days.
It often presents as a maculopapular eruption, meaning it consists of flat, reddened patches covered with small, raised bumps. The coloration of the rash can vary, appearing red on lighter skin tones or dark purplish on darker skin tones. This early rash commonly affects the trunk, face, limbs, and sometimes the palms of the hands and soles of the feet. It may be mildly or intensely itchy, or not at all. The rash often accompanies flu-like symptoms such as fever, headache, fatigue, and swollen lymph nodes, making it easily mistaken for other viral infections. This acute rash is usually transient, resolving within a few weeks without specific treatment.
Skin Conditions Associated with Opportunistic Infections
As HIV infection progresses and the immune system weakens, individuals become more susceptible to opportunistic infections and certain cancers that can manifest on the skin. These conditions often indicate a more compromised immune status.
Kaposi’s Sarcoma (KS)
Kaposi’s Sarcoma (KS) is a type of cancer that frequently appears in people with uncontrolled HIV infection, caused by the human herpesvirus 8 (HHV-8). Skin lesions from KS can vary in appearance, ranging from pink, red, or purplish to reddish-brown or dark brown/black. They may present as flat patches, raised plaques, or nodules, and can appear anywhere on the body, though they are often found on the feet and legs. KS lesions typically do not cause discomfort or itching and do not lose their color when pressed, unlike bruises.
Molluscum contagiosum
Molluscum contagiosum is a viral skin infection that can become widespread and persistent in people with HIV. The lesions are small, flesh-colored or pearly white, dome-shaped papules, often characterized by a central dimple or umbilication. While common in children, in adults with HIV, these lesions can be larger, more numerous (sometimes over 100), and appear on unusual sites like the face, neck, and genital area.
Fungal and Viral Infections
Fungal infections, such as candidiasis (thrush) or tinea, can also present differently or more severely in individuals with HIV. Recurrent or persistent mucocutaneous candidiasis is common, and generalized dermatophytosis may suggest HIV infection. Viral infections like herpes simplex (cold sores or genital herpes) and herpes zoster (shingles) can also be more severe and recurrent. Herpes simplex typically causes painful groups of fluid-filled blisters that can lead to chronic ulcerations, especially around the mouth or genitals. Shingles, caused by reactivated chickenpox virus, manifests as a painful, blistering rash in a stripe on one side of the body, often on the trunk. Its occurrence can indicate a weakened immune system.
Other Common Skin Issues in People Living with HIV
Beyond opportunistic infections, other common skin conditions can be more prevalent or severe in people with HIV, sometimes influenced by the infection itself or its treatments.
Seborrheic dermatitis
Seborrheic dermatitis, a chronic inflammatory skin condition, is notably common, affecting a higher percentage of individuals with HIV compared to the general population. It presents as red, scaly patches with yellowish, greasy scales, typically on oil-rich areas like the scalp, face (eyebrows, nasolabial folds), and chest. In people with HIV, seborrheic dermatitis can be more extensive and resistant to standard treatments.
Psoriasis and Eczema
Pre-existing conditions like psoriasis and eczema may also worsen with HIV infection. Psoriasis, characterized by raised, scaly patches, can become more severe, cover larger body areas, or present with atypical patterns. Generalized dry skin (xerosis) is frequently observed and can lead to intense itching (pruritus).
Drug-related rashes
Some antiretroviral medications can cause various skin rashes. These drug-related rashes can range from mild, self-limiting maculopapular eruptions to severe reactions like Stevens-Johnson syndrome, which involves widespread blistering and peeling skin. The appearance and severity of these rashes vary depending on the specific medication and individual reaction.
Key Considerations and When to Seek Medical Advice
Skin manifestations in individuals with HIV are highly variable and can resemble many common skin conditions. This overlap makes visual diagnosis of HIV based solely on skin symptoms unreliable and potentially misleading. The only definitive way to diagnose HIV is through specific medical tests, not by observing skin changes.
If you develop an unexplained rash or skin changes, especially if accompanied by other symptoms like fever, fatigue, or swollen lymph nodes, seeking professional medical advice is essential. This is particularly important if there is any possibility of recent HIV exposure. A healthcare professional can accurately assess your symptoms, conduct the necessary tests, and provide appropriate care. Early diagnosis and treatment of HIV are crucial for managing the infection, preserving immune function, and preventing serious complications.