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Title: Prevalence of skin disease in patients infected with human immunodeficiency virus in Bangkok, Thailand.
Author: Sivayathorn A, Srihra B, Leesanguankul W.
Journal: Ann Acad Med Singap; 1995 Jul; 24(4):528-33. PubMed ID: 8849182.
Abstract:
A detailed study of the skin lesions of 248 patients infected with the human immunodeficiency virus (HIV) in Bangkok, Thailand, is reported. The study population consisted of 140 patients with asymptomatic disease (stage I), 27 patients with symptomatic disease (stage II), and 81 patients with advanced stage of the disease (stage III). Ninety-five percent of all patients were observed to have one or more skin disorders. Conditions with prevalence higher than 5% included oral candidiasis (34.3%), pruritic papular eruption (32.7%), seborrhoeic dermatitis (21.0%), herpes zoster (16.1%), oral hairy leucoplakia (14.9%), herpes simplex (10.9%), onychomycosis (9.3%), cutaneous ringworm (7.7%), psoriasis (6.5%), and folliculitis (5.6%). Patients in the stage II and III subgroups were found to have a significantly more number of skin disorders than patients in stage I. The prevalence pattern of skin disorders in this study are generally similar to previous studies in the literature. Three notable differences, however, emerge from this study: (1) the high prevalence of pruritic papular eruption in all subgroups, (2) the high prevalence of Penicillium maneffei infection in patients with advanced disease, and (3) the absence of Kaposi's sarcoma in the study population. Knowledge about the cutaneous disease pattern in the locals will be more clinically relevant for proper care of the patients. During July 1993-June 1994 in Bangkok, Thailand, dermatologists examined the skin of 248 HIV-infected patients attending the outpatient clinic or admitted to the medical wards of Siriraj Hospital and performed a CD4+ T-lymphocyte count to determine the prevalence of skin disorders in HIV-infected people and to categorize them into clinical stages. 86% of the patients were male. 140 people were in the asymptomatic group, 27 in the symptomatic group, and 81 in the advanced group (CD4+ 50 cells/sq m). 95% of all HIV-infected patients had at least 1 skin disorder, especially oral candidiasis (34.3%) and pruritic papular eruption (PPE) (32.7%). Other skin disorders included seborrhoeic dermatitis (21%), herpes zoster (16.1%), oral hairy leukoplakia (14.9%), herpes simplex (10.9%), onychomycosis (9.3%), cutaneous ringworm (7.7%), psoriasis (6.5%), and folliculitis (5.6%). No one had Kaposi's sarcoma. 3.2% of all HIV-infected patients had Penicillium maneffei infection, which was limited to only AIDS patients. 9.9% of AIDS patients had Penicilliosis maneffei. Prior to the AIDS epidemic, this infection was unknown to most physicians. AIDS patients were more likely to have at least 3 skin disorders. AIDS patients were more likely to have severe skin lesions than asymptomatic and symptomatic patients (14.8% vs. 9.4% and 7.5%, respectively). Asymptomatic patients had higher prevalence of the frequently seen skin disorders, except cutaneous ringworm, than general patients attending the outpatient clinics (e.g., 3-fold increase for psoriasis, about 25-increase for candidiasis). PPE and oral hairy leukoplakia were unique to HIV infection. This population tended to share a similar pattern of skin manifestations of HIV disease. It is unusual that this population has a high prevalence of PPE and P. maneffei infection and no Kaposi's sarcoma.

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