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HIV-Associated Drug Eruptions !!navigator!!

Basics

  • Drug eruptions are common in the HIV-infected population because of the large number of medications taken by these patients. The most commonly implicated medications are sulfamethoxazole-trimethoprim, to which at least 60% of patients with AIDS develop an allergy, followed by the aminopenicillins.

  • When the drug allergy causes a typical morbilliform eruption, it is possible to continue the offending medication and treat the patient's symptoms with antihistamines and topical steroids. More serious drug eruptions are characterized by urticaria, mucosal involvement, target lesions, erythroderma, and tenderness of the skin. Any of these signs or symptoms requires prompt discontinuation of the offending medication.

  • Mucosal involvement and target lesions are indicative of erythema multiforme or Stevens-Johnson syndrome, whereas erythroderma and skin tenderness are seen in toxic epidermal necrolysis. The non-nucleoside reverse transcriptase inhibitor nevirapine has been associated with severe cases of Stevens-Johnson syndrome. For a complete discussion of drug eruptions, see Chapter 26: Adverse Cutaneous Drug Eruptions.

HIV-Associated Pruritus !!navigator!!

Basics

  • Pruritus is a common and troubling symptom in HIV-infected patients. It often has a multifactorial origin.

  • Many patients use antibacterial or deodorant soaps with the mistaken belief that these will decrease the risk for infection. In fact, these soaps dry the skin and make the patients itchy and more susceptible to cutaneous infection because of the excoriations that results.

  • Patients may become itchy because of subclinical drug eruptions or as a medication-related side effect.

  • Patients may be colonized with Staphylococcus aureus, which is known to be a cause of pruritus in HIV-infected patients.

Management-icon.jpg Management

  • Careful history taking and a physical examination rule out dermatologic disease as the cause.

  • Patients should discontinue use of deodorant and antibacterial soaps; superfatted soaps are the least drying.

  • Patients should be instructed to limit bathing to once per day.

  • Emollients should be applied after the patient has bathed and pats dry; ointments are more emollient than creams, which are more emollient than lotions.

  • Patients need to try different preparations to find which is most cosmetically acceptable and effective.

  • Patients who do not obtain relief with over-the-counter moisturizers often do well with ammonium lactate 12% lotion or cream (Lac-Hydrin).

  • Anti-itch preparations containing calamine, pramoxine, menthol, camphor, and oatmeal may be soothing.

  • Sedating antihistamines are useful, especially before bedtime.

  • Topical steroids should be prescribed for dermatitis, which may result from dry skin.

  • Ultraviolet B phototherapy is palliative.

  • For further discussion of pruritus, see Chapter 24: Pruritus: The “Itchy” Patient.

Outline