According to the American Society of Dermatological Surgery, a skin lesion may appear as a bump, a discolored area, or an ulcer on the skin.
People with HIV may be prone to skin lesions for a number of different reasons.
HIV can reduce the immune system's ability to fight infection.
A person who has a weakened immune system is more likely to develop a variety of skin infections, which may be fungal, viral, or bacterial. They may also develop certain skin cancers.
How does HIV affect the skin?
According to the Centers for Disease Control and Prevention (CDC), as of 2013, about 1.2 million people were living with HIV in the United States.
HIV does not directly affect the skin. However, as HIV affects the body's ability to fight infection, people with HIV have an increased chance of developing certain health problems, including skin conditions.
Skin infections in people with HIV are often called opportunistic infections. Certain viruses and bacteria that may not cause illness in a person with a healthy immune system may be able to infect a person with a weakened immune system.
Skin lesions and rashes may also develop as a side effect of HIV medication.
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.
Lymphocytes are white blood cells that help fight infection. CD4 is a blood test that measures the number of lymphocytes in your body.
The lower a person's CD4 count is, the more likely it is that they will develop certain skin lesions. The higher the levels of CD4 a person with HIV has the better they can fight infections, including those that affect the skin.
It's also 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.
List of common HIV skin lesions
Several different skin lesions commonly develop in people who have HIV. These conditions include:
Image credit: Evanherk, March 2004
Bullous impetigo involves small, blister-like lesions that may burst and leave a yellow crust. They can appear anywhere on the body, but they are most common on the arms, legs, and torso.
In most cases, bullous impetigo lesions do not penetrate the deeper layers of the skin. Infection from Staphylococci bacteria is one of the most common causes of bullous impetigo in people with HIV.
Treatment for mild infections may involve applying an antibiotic ointment. More severe infections may require oral antibiotics.
Washing the area daily with a benzoyl peroxide agent may help dry and remove lesions once they have crusted over.
Human papillomavirus (HPV) warts
HPV warts are small, fleshy skin-colored bumps. They can also develop in people who have HPV but do not have HIV. The condition can become more severe in people with HIV who have a very low CD4 count.
Treatment involves liquid nitrogen cryotherapy, which freezes warts.
This treatment is the same in people who have healthy immune system function and those who have HIV. However, treatment may not be as successful in people with a weakened immune system and warts may reappear.
The presence of Kaposi's sarcoma usually indicates that a person has developed AIDS.
Image credit: OpenStax College, Anatomy & Physiology, Connexion web site, Jun 19, 2013.
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 the 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 AIDS.
According to the American Cancer Society, treatment for Kaposi's sarcoma may involve local therapy, which treats individual skin lesions. Treatment may include surgery, liquid nitrogen to freeze the lesions, and topical retinoid treatment.
Herpes simplex lesions
Skin lesions caused by the herpes simplex virus often appear as small blisters that may burst and crust over. The blisters may take 7 to 10 days to heal.
In some cases, the lesions can be painful. People who have HIV may find that the herpes simplex lesions keep coming back.
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.
Molluscum contagiosum lesions are not usually painful, but an outbreak can cause more than 100 bumps.
Molluscum contagiosum is characterized by smooth, flesh-colored or pink bumps on the skin. The condition is caused by a viral infection.
When an outbreak of molluscum contagiosum occurs in someone with HIV or AIDS, the infection can cause more than 100 bumps. Although the skin lesions are not typically painful, treatment may still be recommended.
The virus is spread by skin-to-skin contact with someone who has the infection or by touching the same object.
Treatment may include applying a medication to the bumps on the skin. Another option involves freezing the bumps with liquid nitrogen or using a laser for removal.
Depending on the number of bumps a person has, treatment procedures may need to be repeated.
Prurigo nodularis is a skin disease that causes crusty, hard lesions on the skin. The lesions on the skin are usually very itchy.
Although prurigo nodularis can occur in anyone, it's much more common in people who have a weakened immune system. Due to the intense itching, some people may scratch the sores, which can cause the skin to become painful and inflamed.
Treatment for prurigo nodularis may include topical steroids to decrease inflammation. In some instances, cryotherapy to freeze the lesions may be effective.
After taking a medical history and examining the lesion, a dermatologist can often make a diagnosis.
In some instances, a skin biopsy may be performed. A skin biopsy involves scraping the skin lesion and examining the cells under a microscope. The biopsy does not treat the skin lesion, but it can identify the cause so that appropriate treatment can be recommended.
A person who has HIV and develops a skin lesion should consider seeing their doctor.
Some lesions may not go away without treatment. Also, lesions can increase in severity making them harder to treat.
Prevention and outlook
Although it may vary, treatment for skin lesions is often the same whether a person has HIV or not.
The length of time it takes for skin lesions to heal may vary according to the cause. Skin infections that develop in people with HIV may take longer to heal or require longer treatment, but this depends on how weakened their immune system is.
It may not be possible to prevent all skin lesions that can develop in people who have HIV, but there are things that can decrease the chances of developing them. Many of the infections that cause skin lesions are opportunistic, so keeping the immune system as strong as possible can help.
Taking antiviral medication may increase a person's CD4 cells, which helps protect them from infection. Eating well, getting enough rest, and exercising regularly can also play a role in keeping the immune system healthy.