AIDS INFORMATION NEWSLETTER Michael Howe, MSLS, Editor AIDS Information Center VA Medical Center, San Francisco (415) 221-4810 ext 3305 August 25, 1995 Opportunistic Infections (Part VII) Dermatitis Skin Problems and HIV Infection Margaret E. Muldrow, MD and Kees Rietmeijer, MD BEING ALIVE; Published by BEING ALIVE / Los Angeles April 1995 Dermatology is a visual specialty. Dermatology is also about touching people-touching their skin to make a diagnosis. Before asking a lot of questions about a particular rash or lesion, dermatologists must look closely and describe for themselves what they see. It is only then that a diagnosis can be made and a treatment plan developed. Almost everyone knows that opportunistic infections in people infected with HIV become more prevalent as CD4 counts fall. This is also true of skin problems in patients with HIV. In fact, almost 100% of all patients with CD4 counts less than 200 will have some sort of dermatologic condition. Although dermatologic conditions like dry skin, seborrheic dermatitis and scabies are not life-threatening diseases (like pneumocystis pneumonia or cryptococcal meningitis), these disorders impact greatly on the quality of life of someone with HIV. It is not uncommon for a dermatologist to be referred a patient who is taking ten different kinds of medications, who has disseminated MAC and is going blind from CMV, who tells us that they can live with all of that, but the thing that is driving them "crazy" is this terrible itch. This tells us something about the patient's quality of life. And the good news is that dermatologists can have a positive impact on a person's quality of life by alleviating some of their symptoms and possibly even curing some of their skin problems. The following is a quick review of a wide range of dermatologic manifestations seen in patients with HIV infections along with the standard treatment. As with all medical treatments, working with your physician is essential because not all people or viruses, bacteria or fungi respond exactly the same every time. Rash of Seroconversion Individuals who are in the process of seroconverting to being HIV+ may develop a fever, malaise, muscle and bone pain, a sore throat, enlarged lymph nodes and even a rash. This rash, which can be described as faint background redness that is distributed primarily over the trunk, is easily missed and lasts only a short period of time. Herpes Simplex The most common skin problems associated with HIV infection are viral in nature. As people become sicker, herpes infections tend to become recurrent, persistent and even widely disseminated. In clinic, dermatologists often see many individuals with perianal herpes. Acyclovir usually clears up the problem in seven to ten days. If the lesions persist, it is often a sign that there is associated infection with bacteria, fungus or even another type of virus. Foscarnet, although a toxic and poorly tolerated medication, can be used for acyclovir resistant strains of herpes. Herpes Zoster In 1982, Dr. Rietmeijer began working at one of the sexually transmitted disease clinics in Amsterdam. At that time, AIDS was perceived as something that was very far away from Amsterdam. It was across the ocean. Nobody thought they would ever have a problem with it there, but by the middle of that year, they began to see more and more gay men with herpes zoster or "shingles." In retrospect, 12 years later, it is obvious that these individuals were infected with HIV and that "shingles" was the first manifestation of their illness. "Shingles" is produced by the same virus that causes chicken pox. Although the chicken pox rash may go away, the individual remains infected with the virus which hides out in the nervous system. As people become sicker and their immune systems become more compromised, the virus is reactivated producing painful blisters along the distribution of a nerve. "Shingles" is treated with acyclovir, but in doses four times that used for the treatment of herpes simplex. Human Papilloma Virus (HPV) This virus produces warts which can occur anywhere on the body including the genitals, anus, mouth, hands, arms and feet. The lesions are often extensive and very hard to treat. Liquid nitrogen and podophylline are the main forms of therapy. Molluscum Contagiosum This is an infection produced by a pox virus. Lesions are described as firm, flesh colored bumps with a central depression which tend to occur on the scalp, face and genital area. They can be very extensive and disfiguring. Treatment is similar to that used for warts. Fungal Infections "Ringworm" and "athlete's foot" are common in patients infected with HIV and can be treated with topical or oral antifungal therapy. Although rare, cryptococcus can involve the skin. Lesions are often mistaken for molluscum. This infection can be life threatening and is more difficult to treat. Bacterial Infections Impetigo, recurrent "boils" and microbacterial infections are also seen. Basilary angiomatosis, which is caused by the "cat scratch" organism, has been described only in HIV+ patients. We have not seen a case of this in Denver. These infections are all treated with antibiotics. Scabies Infection is caused by a mite which burrows into the upper layers of the skin where it lives and lays its eggs. The body's immune response to the mite produces a very itchy rash. Treatment involves the use of Kwell or Permethrim lotion and close followup. Seborrheic Dermatitis More commonly known as "dandruff," this disorder is characterized by yellow to white scale on the scalp. In people infected with HIV, the lesions can also become more extensive (also involving the central face and chest) and more severe. It may also be an initial sign of HIV infection. Treatment includes the use of an anti-dandruff shampoo, topical steroid ointments and antifungals. Psoriasis One to three percent of people with AIDS develop psoriasis. This is a disorder characterized by red bumps and plaques with thick silvery white scale that are most commonly found on the scalp, trunk, elbows, knees and buttocks. It is not an infectious process, but all kinds of infections can make it much worse. Unfortunately, the disorder can become severe (even requiring hospitalization) and is often very difficult to treat. Eosinophilic Folliculitis Nearly all individuals with CD4 counts below 100 will at some time in the course of their illness suffer from severe itching. One disorder that often causes this symptom is eosinophilic folliculitis (commonly called "itchy bump syndrome"). Patients develop very itchy red bumps around the hair follicles on their neck, upper trunk and arms. Since the cause of the disorder is unknown, treatment is empiric with the use of itraconazole and indocin along with good basic skin care. Dry Skin This is a problem for people living in Colorado where the climate is dry, but in particular, for people infected with HIV. Treatment involves taking fewer showers or baths and the use of lots of moisturizers and topical steroids. Drug Reactions Reactions to medications are more common in people who are HIV+ than in the general population and reactions become more frequent as the disease progresses. Bactrim and penicillin cause the most reactions, but people with central nervous system toxoplasmosis who are taking anti-seizure medications appear to be at high risk for the most serious kinds of drug reactions. (This article was excerpted from the presentation given by Margaret F. Muldrow, MD and Kees Rietmeijer, MD at the 10th Annual Rocky Mountain Regional Conference on HIV Disease held February 2-4, 1995 in Denver, CO and is reprinted from the April 1995 issue of Resolute!) Copyright (c) 1995 - BEING ALIVE/Los Angeles. Distributed by AEGIS, your online gateway to a world of people, information, and resources. 714.248.2836 * 8N1/Full Duplex * v.34 ====================== Project Inform Fact Sheet ====================== Dermatologic Manifestations [Reprinted from: STEP PERSPECTIVE, Vol. 2, No. 4, June 1992, pages 16-17,30] Skin Manifestations Related to HIV by Laury McKean, R.N. FOR YEARS, TELEVISION ADVERTISING has been selling remedies for skin problems by talking about the 'heartbreak of psoriasis', and the social consequences of dandruff. However, afflictions of the skin, nails, and hair are a serious concern for HIV-infected people. They occur in up to 90% of people with AIDS, and often people suffer from two or more skin related disorders at one time. This article discusses the most commonly seen skin conditions and ways to treat them. SEBORRHEIC DERMATITIS Seborrheic dermatitis is extremely common in people with HIV. It is more commonly known as dandruff when it affects the scalp. It is also commonly found on the face (especially around the eyebrows), chest, back, groin and armpits. The affected area is usually red with a yellowish, greasy scale. When the lesions are limited to the face, they are usually asymptomatic, but when other areas are affected, it can cause itching. Seborrheic dermatitis may be caused by a fungus, Pityrosporum ovale. Treatment for the scalp includes regular use of dandruff shampoos containing selenium sulfide (selsun), zinc pyrithione (Head & Shoulders, Danex, Zincon),or sulfur and salicylic acid (Vanseb, Sebulex). A medium-potency steroid solution, such as triamcinolone 0.1 %, may be added to the treatment regimen if the shampoos don't control it. For lesions on the face and other parts of the body, ketoconazole cream, sometimes in combination with hydrocortisone cream applied twice daily is usually effective. For severe cases, a 2 to 4 week course of oral ketoconazole, 200) to 400 mg daily, may be of benefit. Individuals who have recurrent episodes of seborrheic dermatitis may benefit from using dandruff shampoo as an all over body wash to prevent the episodes. PSORIASIS Psoriasis often occurs as a new disease after HIV infection. Individuals with preexisting psoriasis who become infected with HIV may experience a more severe form. The initial lesions often begin like seborrheic dermatitis, but usually spread to the armpits and groin, then to the elbows, knees, and lower back. Psoriasis lesions in the armpits and groin look identical to seborrheic dermatitis, but when psoriasis involves the trunk, it tends to be more fixed and with thicker scales. Psoriatic arthritis occurs more often in people with HIV than those who are HIV negative. Mild to moderate psoriasis usually responds well to topical corticosteroids, anthralin, or tar. Wide spread disease is more difficult to treat, but significant improvement is often seen using AZT at higher doses. With a dosage of 200 mg every 4 hours of AZT, relief of itching can occur within a week and partial or even complete clearing can be seen within 6 to 8 weeks. However, when the dose is reduced or stopped, the psoriasis recurs. Phototherapy (exposure to various concentrated light rays) has also been used effectively in severe cases, however this therapy could be immunosuppressive. HERPES SIMPLEX VIRUS The majority of herpes infections in people with HIV are due to reactivation of the latent virus. The most common sites of the herpes outbreaks are, in order of frequency, perianal, genital, around the mouth and oral cavity, and the fingers. The lesions typically begin as a small cluster of blisters on top of a reddened area and then form shallow ulcers or crusted lesions as they are healing. These lesions will often heal within one to two weeks without treatment. However, as immune deficiency progresses, these lesions can become more progressive an persistent, requiring prompt treatment. @o Herpes outbreaks in early HIV infection often respond well to topical acyclovir cream. If this fails, oral acyclovir at a dose of 200 mg 5 times a day is usually effective. For extensive infections, intravenous acyclovir can be used. Acyclovir-resistant strains of the virus can occur and may respond to treatment with intravenous foscarnet or vidarabine. Because the herpes virus contributes to immune suppression, many physicians now prescribe oral acyclovir, 400 mg twice a day, to individuals who have problems with recurrent herpes outbreaks as a prophylaxis to prevent the outbreaks from occurring and further suppressing the immune system. Some believe this practice will increase the chances of developing acyclovir-resistant strains, But physicians who use prophylactic acyclovir therapy claim they see less resistant strains in patients who are using daily prophylactic acyclovir than in patients who only receive acyclovir as a treatment for a herpes outbreak. HERPES ZOSTER Herpes Zoster or "shingles" is caused by the varicella zoster virus (VZV), which is a member of the herpes virus family. This virus lies dormant in the body after a person has had an outbreak of chickenpox and can become reactivated when immune suppression occurs. Herpes zoster is seven times more common in people with HIV than HIV negative individuals. It can occur early in the course of HIV infection as well as late. The initial symptom of herpes zoster is the sensation of pain (may require a pain relief drug), burning or tingling in one area of the body that is very tender if touched or if clothing rubs against it. A red rash of small, fluid-filled blisters will appear usually in a distinct pattern, and the pain will increase. The rash correlates with the location of the infected dermatome (nerve), most commonly around one side of the torso. In people with HIV, more than one dermatome can be infected at the same time, including the face, eyes, and mouth. The blisters generally begin to crust over and heal within two weeks, but often high-dose acyclovir must be used as treatment. Intravenous acyclovir may be necessary in severe or widespread cases, especially those involving the eye. Acyclovir resistant strains of herpes zoster can also occur. These strains appear to be sensitive to vidarabine or foscarnet. There are some topical creams, Axsain and Zostrix, which may help decrease pain which persists after the blisters are gone. MOLLUSCUM CONTAGIOSUM Molluscum contagiosum is a viral infection which occurs in 10 to 20% of people with symptomatic HIV disease. The lesions can appear anywhere, but are most commonly found on the face (especially the eyelids), genital area, and buttocks. They appear as raised, flesh-colored, centrally indented bumps with a pearly border and can number from one to hundreds. The lesions can be spread easily by shaving or scratching. This spreading may be reduced by shaving the infected facial areas last with a disposable razor, and by refraining from scratching them. Treatment Of molluscum contagiosum can be difficult. The most common methods are cryotherapy (freezing) with liquid nitrogen, removal with a sharp instrument, or light electrocautery. Therapy with AZT has also been reported to be effective in some cases. Retinoic acid (Retin A) cream has been used to slow down the appearance of new lesions, but does little to help lesions that are already present and can't be used on the eyelids or genitals. A clinical trial of alpha interferon for treatment of molluscum contagiosum is under-way. HUMAN PAPILLOMAVIRUS (HPV) Human papillomavirus is the virus that causes warts which are seen with increased frequency in people with HIV. In most cases they appear as regular or flat warts, but are often seen in multiple numbers in people with HIV and can be more difficult to treat. Genital warts can be particularly troublesome. Therapy can include cryotherapy, electrocautery, excision, or injections of alpha interferon directly into the lesion. Because genital warts can lead to Cancer, treatments should be discussed with your physician. XERODERMA Xeroderma, better known as dry skin, occurs in 23 to 30% of HIV infected individuals. It appears as a flat, slightly scaly rash which comes and goes. It can occur anywhere on the body, but is most commonly found on the front of the lower legs. The cause of this is unknown. There does not appear to be any correlation with the degree of immunosuppression, suggesting it may be directly related to HIV. Other possible causes include malnutrition, long standing illness, poor hygiene, or immunologic deficit. The use of bath oils, lotions, and Dove soap may be beneficial. Also, decreasing the frequency of bathing and lowering the temperature of the water may help. FOLLICULITIS Folliculitis appears as red pustules around hair follicles that can itch severely. It can be seen anywhere, but is often found on the trunk. Folliculitis is often caused by the bacteria staphylococcus, which responds well to treatment with antibiotics such as dicloxacillin, in about 7 to I 0 days. Eosinophilic folliculitis can also occur. The cause of this extremely itchy rash is unknown, but it usually is controlled by ultraviolet light treatment. It can also be caused by a fungus, Pityrosporum. This type of folliculitis usually occurs on the upper trunk and arms. It responds well to ketoconazole treatment. BACILLARY ANGIOMATOSIS Bacillary angiomatosis is a newly described infection that is rarely seen in non HIV infected individuals. It appears as papules or nodules that are usually purplish to bright red and often resemble Kaposi's sarcoma. The lesions are firm and non blanching (they do not turn white when you push on them). They can occur anywhere on the body in numbers ranging from one to hundreds but are rarely seen on the palms, soles, or in the mouth. High fever is usually present and the infection can spread to the bone, bone marrow, spleen, lymph nodes and liver. It can be easily treated with antibiotics such as erythromycin and doxycycline. Treatment is given until the lesions resolve, usually in 3 to 4 weeks. In some people, the lesions can regress without treatment. PHOTODERMATITIS Photodermatitis is the eruption of itchy, thick, scaly patches on portions of the skin that are commonly exposed to the sun. It can also resemble a bad sunburn. These areas can also turn lighter in color than the rest of the skin. Photodermatitis is rarely caused by HIV disease, but certain medications that people with HIV commonly take such as sulfa drugs, hypericin, and nonsteroidal anti-inflammatory drugs predispose people to hypersensitivity to the sun. This condition can be managed with relative case if it is recognized, but if the condition is ignored can worsen and will not respond as easily. Photodermatitis is managed by discontinuing, if possible, any medications that may be contributing to the condition, avoiding exposure to the sun with clothing, hats, and sunblocks, and applying medium to high-potency steroid creams to the lesions. INSECT BITE REACTIONS People with HIV often have exaggerated responses to insect bites including mites, fleas, mosquitoes, and spiders. Often the location of the eruption will give clues as to what the offending insect is. When lesions and itching occur between the fingers, feet, armpits, or genitals, scabies mites should be suspected. As immunodeficiency progresses, HIV infected people are more apt to experience crusted (Norwegian) scabies, in which the number of scabies can be in the millions. Treatment with gamma benzene hexachloride or permethrin lotion is usually effective, although in crusted scabies, lotion may need to be applied to the entire body. Demodicidosis, caused by demodex mites, causes an itchy eruption most commonly occurring on the scalp, face, and neck. These mites usually respond well to the same treatment as the scabies mites. The itching caused by mosquitoes, fleas, and spider bites can be unrelenting. These can best be managed by 1) attempting to eliminate the insects from your environment with insecticides, 2) making your body less attractive to insects with insect repellents containing diethyl toluamide and 3) blocking the reaction to the bite with regular doses of antihistamines. DRUG REACTIONS People with HIV are at increased risk for developing allergic reactions to medications. Also, some underlying opportunistic infections such as cytomegalovirus or Epstein Barr virus in people with HIV may predispose them to adverse drug reactions. As many as 70% of people with HIV develop adverse reactions to Bactrim (Septra) which is commonly prescribed as prophylaxis for Pneumocystis carinii pneumonia. The most common symptom of adverse drug reactions is a widespread red rash across the back, chest, arms, and legs, and occasionally involving the face and mucous membranes. The rash can be flat, resembling a sunburn, or with red raised bumps. Although any drug can cause this type of reactions, the most common ones are antibiotics, such as penicillin's and sulfa drugs. The reactions will resolve when the offending, drug is removed. Antihistamines, H1 or H2 blockers, or steroids are sometimes used to help block the reaction. Occasionally, people can be desensitized to drugs which have previously caused adverse reactions. Desensitization is achieved by administering small amounts of the drug, gradually increasing the dosage over a period of time. Desensitization should only be attempted under the close supervision of your physician. AZT can cause hyperpigmentation of the skin and mucous membranes, although it only appears to affect the mucous membranes in black people. Foscarnet has induced painful ulceration's of the penis in some individuals receiving high doses. These ulcers resolved spontaneously in all and without discontinuing treatment in about 50%. NAIL DISORDERS Yellow discoloration of the nails has been seen frequently in people with Pneumocystis carinii pneumonia. Fungal infections can also cause yellowing of the nails as well as thickening. Because the nails are difficult to penetrate with antifungals and because nails take a long time to grow, fungal infections of the nails are extremely difficult to treat. AZT can cause blue to brown-black discoloration of the nails, more so in those individuals receiving higher doses. The discoloration usually starts about 4 to 8 weeks after beginning AZT. Longitudinal streaks on the thumbnails are the most common. HAIR CHANGES People with HIV often develop thinning of scalp as well as body hair for unknown reasons. This thinning can be worsened if seborrheic dermatitis is present. Sudden premature graying is also seen more frequently with HIV, probably as a result of malnutrition. Other hair changes seen more frequently in people with HIV are hypertrichosis of the eyelashes, and alopecia (balding). In addition, lengthening, lightening color, and softening of the hair can occur in black people. Effective treatments are available for many of the conditions described above, and results are particularity good when the problem is diagnosed and treated as early as possible. Early treatment also increases a person's comfort, well being, and physical appearance. If you or someone you care for is leaving skin problems, do not hesitate to consult a dermatologist who is experienced in treating HIV related conditions. ----------------------------------------------------------------- CHART: Skin Manifestations Associated with HIV Infection Seborrheic Dermatitis ---------------------- CONDITION: Appears as dandruff when the scalp is affected. Other areas develop red patches which may itch and have a greasy, yellowish scale. LOCATION: Usually affects the scalp, face (especially the eyebrows and sides of the nose), chest, back, groin, and armpits. TREATMENT: Dandruff shampoo, ketoconazole cream 2%, sometimes in combination with hydrocortisone 2.5% creams applied twice a day. For severe cases 200-400 mg oral ketoconazole a day may be necessary. DURATION OF TREATMENT: Until lesions resolve Oral ketoconazole: 2-4 weeks. Prophylactic use of dandruff shampoo as a body wash may be effective in individuals with recurrent episodes. Psoriasis ---------- SYMPTOMS: Appears similar to seborrheic dermatitis but more fixed with thick scales and a silver tinge. LOCATION: Commonly appears in areas such as armpits, groin, elbows, knees, and the lower back. TREATMENTS: Mild to moderate: topical corticosteroids, anthralin, or tar Widespread: 200 mg AZT every 4 hours Severe: phototherapy DURATION OF TREATMENT: Indefinitely Herpes Simplex Virus --------------------- CONDITION: Appears as small clusters of blisters on top of a reddened area, progressing to shallow ulcers, that form crusted lesions as they are healing. The lesions usually heal without scaring. LOCATION: Lesions occur most commonly in the following order: perianal, genital, face, finger. TREATMENT: Mild: acyclovir cream Moderate: 200 mg oral acyclovir 5 times a day. Severe: intravenous acyclovir. Prophylaxis: 400 mg acyclovir twice a day DURATION OF TREATMENT: 7 - 10 days or until healed with no new lesions for 3 days Indefinitely Herpes Zoster (Shingles) -------------------------- SYMPTOMS: Usually begins with the sensation of pain, burning, or tingling, followed by a red rash of small blisters which follow the dermatome (nerve) in a distinct pattern. LOCATION: Most commonly appears around one side of the torso, but can be found along any dermatome line, including the face. It can affect more than one dermatome at a time. TREATMENT: Mild to Moderate: 800 mg oral acyclovir 5 times a day. Severe (involving one or more dermatome or the eye): 10 mg/kg intravenous acyclovir every 8 hours. Symptom relief: Axsain or Zostrix cream applied to intact skin. DURATION OF TREATMENT: 7 to 10 days Until no new blisters for 3 days, then switch to oral acyclovir. As needed. Molluscum Contagiosum ---------------------- SYMPTOMS: Appear as raised, flesh-colored bumps with a pearly border which are indented in the middle. LOCATION: Most commonly found on the face (especially the eyelids), genital area, and buttocks. TREATMENT: Retin A cream or AZT may be effective in some cases. Cryotherapy (freezing), electrocautery, or excision can be used for severe cases or cosmetic reasons. As necessary DURATION OF TREATMENT: Repeat every 2 to 3 weeks until resolved. Human Papillomavirus (HPV) --------------------------- SYMPTOMS: Usually appear as regular or flat warts often in multiple numbers LOCATION: They commonly appear in the anogenital area, but can be found anywhere on the body. TREATMENT: Cryotherapy, electrocautery, excision, or other destructive techniques. DURATION OF TREATMENT: Anogenital: injections of alpha interferon directly into the lesion. Repeatedly until resolved. Bacillary Angiomatosis ------------------------ SYMPTOMS: Appear as purplish to red spots which are firm and do not turn white when pressure is applied, The lesions often resemble Kaposis Sarcoma, but a fever or general malaise is usually present. LOCATION: The lesions can occur anywhere on the body, but rarely on the palms, soles, or int the mouth. It can spread to the bone, bone marrow, spleen, lymph nodes, and liver. TREATMENT: 500 mg erythromycin 4 times a day or 100 mg Doxycycline 2 times as day. DURATION OF TREATMENT: 2 - 3 weeks for skin lesions. If the infection has spread in internal organs or bone, treat for at least six weeks. Photodermatitis ---------------- SYMPTOMS: Usually appears as itchy, scaly patches or it may resemble a bad sunburn. The affected areas my turn lighter in color than the unaffected skin LOCATION: Occurs on portions of the skin that are frequently exposed to the sun, such as the neckline. TREATMENT: Protection from the sun using clothing and/or sunscreens. Topical or systemic steroids may be used for severe cases. Discontinue photosensitizing drugs if possible. DURATION OF TREATMENT: Continuously during sunny weather. As needed. Staphylococcal Folliculitis ---------------------------- SYMPTOMS: Appears as small red bumps around hair follicles which may resemble pimples, but itch severely. LOCATION: Most commonly found on the face, groin, and trunk TREATMENT: Mild to moderate: 500 mg dicloxacillin 4 times a day. Severe: add 600 mg rifampin a day to the dicloxacillin. DURATION OF TREATMENT: dicloxacillin: 7 - 10 days, rifampin: 5 days Eosinophilic Folliculitis -------------------------- SYMPTOMS: Appears as small red bumps around hair follicles which may resemble pimples, but itch severely. LOCATION: Most commonly found on the trunk and face TREATMENT: Ultraviolet light treatments performed by a dermatologist. DURATION OF TREATMENT: As needed. Fungal Folliculitis -------------------- SYMPTOMS: Appears as small red bumps around hair follicles which may resemble pimples, but itch severely. LOCATION: Commonly appears on the upper trunk and arms. TREATMENT: 200 to 400 mg oral ketoconazole. DURATION OF TREATMENT: 10 to 14 days Xeroderma (Dry Skin) -------------------- SYMPTOMS: Generally appears as a scattered, flat slightly scaly rash which comes and goes sporadically. LOCATION: Can occur anywhere on the body but is most commonly found on the front of the lower legs. TREATMENT: Bath oils, moisturizing lotions, Dove soap, and decreasing the frequency of bathing and the temperature of the water may be beneficial. DURATION OF TREATMENT: As needed. Drug Reactions ---------------- SYMPTOMS: Commonly appears as a widespread red rash which may be flat (resembling a sunburn) or with raised bumps. LOCATION: Usually appears across the back, chest, arms, and legs, and sometimes involves the face. TREATMENT: Discontinue the drug which caused the reaction if possible. Antihistamines, steroids, H1 or H2 blockers may be helpful. DURATION OF TREATMENT: As long as needed. Steroids should be used for no more than 4 weeks. Kaposi's Sarcoma (KS) ---------------------- SYMPTOMS: The lesions my be red, purple, blue or black. They are generally flat, painless and do not ich or drain. They look similar to a bruise, but do not blanche when pressure is applied. They may become elevated, patch-like, and flow together as they progress. LOCATION: The lesions can occur anywhere on the body, but the most common sites in one large study were as follows: 52% trunk, 45% legs, 40% oral cavity, 38% arms, 33% Face. The lesions can also involve the gastrointestinal tract, lungs, lymph system, and other internal organs. TREATMENT: Localized lesions: radiation therapy, injections of alpha interferon directly into the lesions, or Retin-A. Widespread lesions: chemotherapy or subcutaneous alpha interferon.: DURATION OF TREATMENT: Until lesions resolve. Insect Bite Reactions ----------------------- SYMPTOMS: Appear as either single or multiple red, raised bumps which may itch intensely LOCATION: Scabies mites: between the fingers, feet, armpits, or genitals Demodex mites: scalp, face, and neck. Fleas: most commonly affect the lower legs. Mosquitoes: most commonly affect the arms and legs. TREATMENT: Gamma benzene hexachloride or permethrin lotion. DURATION OF TREATMENT: Once a week for two weeks. Antihistamines, insect repellents, insecticides. DURATION OF TREATMENT: As needed. ================================================================= Pass this information on to people who need it. You have permission to reproduce this information if you credit Project Inform and list our hotline number: 800-822-7422. Project Inform has a wide range of information on current HIV/AIDS treatments, diseases and related topics. Check the Project Inform folder or call Project Inform. At Project Inform we do not always have the resources to produce our own informational material for every treatment topic. We try to provide copies of treatment information from reliable publications, but cannot confrim that every fact in these publications is accurate. We encourage you to check out the publications from which this information is taken; a resource list is available form Project Inform's Hotline. Copyright- San Francisco Project Inform, 1994 Project Inform 1965 Market St., Suite 220, San Francisco, CA 94103, Offices 415-558-8669 Fax, 415-558-0684 Hotline Number 800-822-7422 or 415-558-9051 Hotline hours: Mon - Sat, 10am - 4pm Pacific time