Many people with HIV experience skin problems due to the impact of the virus on the immune system. In many cases, this can include skin lesions.
HIV is a virus that targets the immune system. When the immune system loses strength, it is less able to fight off infections. This increases a person’s risk of various infections and diseases.
A weakened immune system makes it more likely that a person will develop various skin infections, which may be fungal, viral, or bacterial. Certain types of skin cancers are also more likely to occur in people with HIV.
Skin conditions may represent opportunistic infections, other illnesses associated with HIV, or side effects of HIV medications.
This article looks at the ways HIV affects the skin, common causes of skin lesions in people with HIV, their diagnosis, and how to prevent them.
According to the Centers for Disease Control and Prevention (CDC), around 1.2 million people in the United States are living with HIV.
HIV does not directly affect the skin. However, HIV damages or destroys the immune system’s CD4 cells, which reduces the body’s ability to fight infection. This increases the risk of certain health problems, including skin conditions.
Dermatological conditions are common among people with HIV. Some sources have suggested that 69% of participants with HIV have a skin disorder.
Certain infections in people with HIV are often called opportunistic infections. These are infections that typically cause mild symptoms, but can cause severe symptoms for a person with a weakened immune system.
Some opportunistic infections that affect the skin include:
- herpes simplex virus, a viral skin infection
- candidiasis or yeast infection, a fungal skin infection
- Kaposi’s sarcoma, a type of cancer that rarely occurs in people who do not have HIV
Some HIV medications can cause skin lesions or rashes as a side effect. Some antiretroviral drugs are more likely to cause skin rashes than others. This includes nevirapine, efavirenz, and abacavir.
The severity of skin lesions can vary. In some cases, only a small area of the skin is affected. In other instances, dozens or more skin lesions can develop.
It’s important to understand that people who do not have HIV can also develop a variety of skin lesions. Having certain skin lesions does not necessarily mean that a person has HIV.
Various skin conditions that cause lesions are common among people with HIV. These conditions include:
Seborrheic dermatitis is a skin condition that causes patches of scaly skin, swelling, and itching. Common areas affected include the hairline and the nasolabial folds, which are the indentations on the face that run from the edges of the nose to the outer corners of the mouth.
This skin condition is common, especially in people with immune conditions. According to some sources, it affects 1–3% of the general population and 34–83% of people with weakened immune systems.
Seborrheic dermatitis is caused by an overgrowth of fungus that usually lives harmlessly on the skin. It is not contagious.
The Department of Veteran Affairs report that, without effective antiretroviral treatment, up to 40% of people with HIV and 80% of those with advanced HIV have seborrheic dermatitis.
In people with HIV, seborrheic dermatitis usually improves with effective antiretroviral therapy.
Typical treatments include antifungal agents, such as topical ketoconazole. Antifungal shampoos can treat seborrheic dermatitis of the scalp.
Folliculitis is an inflammation of the hair follicle. A type of folliculitis called eosinophilic folliculitis is associated with HIV, particularly in people with low CD4 counts.
HIV-associated eosinophilic folliculitis appears as 2–3 millimeter swollen, itchy papules. They are most common on the shoulders, trunk, upper arms, neck, and forehead.
Several treatments may help, including oral and topical medications such as steroids or antibiotics. Antiretroviral therapy tends to greatly reduce or eliminate symptoms.
The two herpes simplex viruses (1 and 2) can cause painful lesions, known as cold sores or fever blisters, to appear around the mouth. They can also cause painful ulcers around the genitals or anus.
People who have HIV may find that the herpes simplex lesions keep coming back. After a person contracts the herpes virus, it remains in the spinal cord ganglia for life. Herpes lesions may be one of the earliest signs of an undiagnosed HIV infection.
In people with very damaged immune systems, the herpes simplex virus can also cause:
- infections of the bronchus, or breathing tube
- pneumonia, an infection of the lungs
- infections of the esophagus, the tube that connects the mouth and stomach
- infections of the liver causing jaundice or other liver damage
Treatment for herpes simplex lesions is usually the same whether a person has HIV or not. Treatment usually includes acyclovir, which is a medication taken by mouth, or other acyclovir-related drugs.
Human papillomavirus (HPV) can cause warts, or small, fleshy skin-colored bumps. These warts can also develop in people who have HPV but do not have HIV.
HPV lesions tend to go away without treatment. In people with HIV and a very low CD4 count, the condition can become more severe, take longer to go away, and is more likely to recur.
Many younger people are getting HPV vaccines, so in the future, fewer people may have HPV-related skin complications.
Treatments for HPV warts is the same in people with and without HIV. It may involve liquid nitrogen cryotherapy, which freezes warts.
Effective antiretroviral therapy can reduce the risk of developing HPV-related cancers.
The available vaccines against HPV will not treat current infections.
In addition to the skin, Kaposi’s sarcoma can also affect other parts of the body, such as the liver and the lungs.
In most instances, the condition develops when a person’s CD4 cell count is low, which indicates the immune system is significantly weakened.
If a diagnosis of Kaposi’s sarcoma is made, this usually means that a person with HIV has developed an advanced HIV infection, also known as AIDS.
According to the American Cancer Society, antiretroviral therapy may be the only treatment needed to keep the lesions under control.
Other treatment may involve local therapy, which treats individual skin lesions. This may include surgery, liquid nitrogen to freeze the lesions, or topical retinoid treatment.
Molluscum contagiosum is characterized by smooth, flesh-colored or pink bumps on the skin. This infection is caused by a virus that is transmitted between people.
Anyone can get molluscum contagiosum, but it may be more severe in a person with HIV. In this population, the bumps may be large and grow across large areas of skin.
The American Academy of Dermatology say that antiretroviral therapy is the treatment of choice for people with HIV and molluscum contagiosum.
Other treatment may include topical medicine, freezing the bumps, or laser removal. Depending on the number of bumps, the person may need more than one treatment.
Prurigo nodularis is a very itchy skin disease of unknown cause that causes crusty, hard lesions on the skin.
Although prurigo nodularis can occur in anyone, it is much more common in people who have a weakened immune system. When scratched, the sores can become painful and inflamed.
Treatment for prurigo nodularis may include topical steroids to decrease inflammation. Cryotherapy to freeze the lesions may be effective.
A doctor specializing in skin, known as a dermatologist, can often determine the cause of skin lesions through a physical examination and taking the person’s medical history.
They may use a skin biopsy to help diagnose the cause. This involves scraping the lesion and examining the skin cells under a microscope.
While this article covers some possible causes of skin lesions in HIV, there are many other skin conditions that can cause this symptom.
If a person develops skin lesions of unknown cause, they may benefit from talking to a doctor who specializes in HIV or skin conditions.
Skin infections that develop in people with HIV may take longer to heal or require more extensive treatment, but this depends on how weakened the person’s immune system is. The length of time it takes for skin lesions to heal also varies depending on the cause.
The most effective way for someone with HIV to prevent HIV-related complications, including opportunistic infections, is to take antiretroviral therapy consistently and as prescribed.
Antiretroviral therapy reduces the amount of HIV in the body to very low levels. That allows the body to replace damaged immune system cells, called CD4 cells, which help keep the body healthy and fight off infections.
When the amount of HIV in the person’s body is undetectable, the virus no longer damages their immune system and it cannot be transmitted to others. This is known as undetectable = untransmittable (U=U).
Eating well, getting enough rest, and exercising regularly can also play a role in keeping the immune system healthy.
HIV is a virus that gradually weakens the immune system. This increases the risk of infections and disease, some of which affect the skin.
Taking antiretroviral therapy as prescribed helps to keep the immune system healthy, reducing the frequency and severity of infections and disease.