Many people with HIV have skin problems due to the effects of the virus on the immune system. In many cases, this may 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 a person more likely to develop various skin infections, which may be fungal, viral, or bacterial. Certain types of skin cancer are also more common among people with HIV.
Skin conditions can be opportunistic infections, other illnesses associated with HIV, or side effects of HIV drugs.
This article explores the effects of HIV on the skin, the most common causes of skin lesions in people with HIV, their diagnosis and prevention.
How does HIV affect the skin?
According to the Centers for Disease Control and Prevention (CDC), around 1.2 million people live with HIV in the United States.
HIV does not have a direct effect on the skin. However, HIV damages or destroys the CD4 cells of the immune system, which reduces the body’s ability to fight infections. This increases the risk of certain health problems, including skin conditions.
Dermatological diseases are common among people with HIV. Some sources suggest that 69% of HIV participants have a skin condition.
Certain infections in people with HIV are often referred to as opportunistic infections. These are infections that usually cause mild symptoms but can cause serious symptoms in 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 without HIV
Some HIV medications may cause skin lesions or rashes as a side effect. Some antiretroviral drugs are more likely to cause skin rashes than others. These include nevirapine, efavirenz, and abacavir.
The severity of skin lesions may vary. In some cases, only a small area of a person’s skin is affected. In other cases, dozens or more skin lesions may develop.
It is important to understand that people who do not have HIV can also develop a wide variety of skin lesions. Certain skin lesions do not necessarily mean that a person has HIV.
For more information and resources about HIV and AIDS, visit our dedicated hub.
List of common HIV skin lesions
Various skin conditions that cause lesions are common among people with HIV. These conditions include:
Seborrheic dermatitis is a skin condition that causes scaly patches of skin, swelling, and itching. Commonly affected areas include a person’s hairline and nasolabial folds — the depressions in the face that run from the edges of the nose to the outer corners of the mouth.
Seborrheic dermatitis is common, particularly among people with immune disorders. According to some sources, it affects 1-3% of the general population and 34-83% of people with weakened immune systems.
An overgrowth of fungi, which normally lives harmlessly on the skin, causes seborrheic dermatitis. It is not contagious.
The Department of Veteran Affairs reports that without effective antiretroviral treatment, up to 40% of people with HIV and 80% of people with advanced HIV suffer from seborrheic dermatitis.
In people with HIV, seborrheic dermatitis usually improves with effective antiretroviral therapy.
Typical treatments include antifungal drugs such as topical ketoconazole. Antifungal shampoos can treat seborrheic dermatitis of a person’s scalp.
Read more about treatments for seborrheic dermatitis here.
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 levels.
HIV-associated eosinophilic folliculitis occurs as 2-3 millimeters of swollen, itchy papules. They are most common on the shoulders, trunk, upper arms, neck, and forehead.
Several treatments can help, including oral and topical medications, such as steroids or antibiotics. Antiretroviral therapy tends to sharply reduce or eliminate symptoms
The two herpes simplex viruses (1 and 2) can cause painful lesions, called cold sores or fever blisters, to occur around a person’s mouth. They can also cause painful ulcers around the genitals or anus.
People with HIV may find that the herpes simplex lesions keep coming back. After a person is infected with 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 severely damaged immune systems, the herpes simplex virus can also cause:
- Bronchus infections or respiratory tube pneumonia
- , an infection of the lungs
- Infections of the esophagus, the tube that connects the mouth and stomach
- Liver infections that cause jaundice or other liver damage
The treatment for herpes simplex lesions is usually the same regardless of whether a person has HIV or not. Treatment usually includes acyclovir or other acyclovir-related medicines.
Human papilloma virus (HPV) can cause warts or small, fleshy, skin-colored bumps. These warts can also develop in people who have HPV but don’t have HIV.
HPV lesions usually disappear without treatment. People with HIV and a very low CD4 count may get worse, take longer to disappear, and are more likely to recur.
Many younger people are getting HPV vaccines, so fewer people may have HPV-related skin complications in the future.
The treatment of HPV warts is the same for people with and without HIV. It may include liquid nitrogen cryotherapy, which freezes warts.
Effective antiretroviral therapy may reduce the risk of developing HPV-related cancers.
The available vaccines against HPV cannot treat current infections.
Learn more about HIV and HPV here.
Kaposi’s sarcoma is a type of cancer that causes skin lesions that may appear red, brown, or purple. The lesions usually appear as patches or knots.
Kaposi’s sarcoma can also affect other parts of the body, such as the liver and lungs.
In most cases, the condition develops when a person’s CD4 cell count is low, which indicates a significantly weakened immune system.
A diagnosis of Kaposi’s sarcoma 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 person’s lesions under control.
Another treatment may include local therapy, which treats individual skin lesions. This may include surgery, liquid nitrogen to freeze the lesions, or topical retinoid treatment.
Additional therapy to treat multiple lesions or Kaposi’s sarcomas that have affected other organs may include chemotherapy, radiotherapy, or immunotherapy.
Molluscum contagiosum is characterized by smooth, flesh-colored or pink bumps on the skin. A virus causes this infection, which is transmitted between people.
Anyone can get molluscum contagiosum, but it can be more serious in a person with HIV. In this population, the bumps can be large and grow over large areas of skin.
The American Academy of Dermatology says antiretroviral therapy is the treatment of choice for people with HIV and molluscum contagiosum.
Other treatments may include topical medications, bump-freezing, or laser removal. Depending on the number of bumps, the person may need more than one treatment.
Prurigo nodularis is a very itchy skin condition of unknown origin that results in crusty, hard skin lesions.
Although prurigo nodularis can occur in anyone, it is much more common in people with a weakened immune system. If scratched, the wounds may become painful and become inflamed.
Treatment for prurigo nodularis may include topical steroids to reduce inflammation. Cryotherapy to freeze the lesions may be effective.
A doctor who specializes in skin, known as a dermatologist, can often determine the cause of skin lesions through a physical examination and based on the person’s medical history.
You can use a skin biopsy to diagnose the cause. This includes scraping off the lesion and examining the skin cells under a microscope.
Skin infections that occur in people with HIV may take longer to heal or require more extensive treatment. However, this depends on how weakened the person’s immune system is. The duration of healing of skin lesions also depends on the cause.
The most effective way for a person with HIV to prevent HIV-related complications — including opportunistic infections — is to provide consistent and prescribed antiretroviral therapy.
antiretroviral therapy reduces the amount of HIV in the body to a very low level. In this way, the body can replace damaged immune system cells called CD4 cells, which help keep the body healthy and ward off infections.
When the amount of HIV in the person’s body is undetectable, the virus no longer damages their immune system and cannot be transmitted to others. This is referred to as undetectable = not transferable (U=U).
Eating well, getting enough rest, and exercising regularly can also help keep a person’s immune system healthy.
Other skin conditions
While this article discusses some possible causes of skin lesions in HIV, many other skin conditions can cause this symptom.
If a person develops skin lesions of unknown origin, they may benefit from talking to a doctor who specializes in HIV or skin conditions.
Click here to learn more about skin lesions.
HIV is a virus that gradually weakens a person’s immune system. This increases the risk of infections and diseases, some of which affect the skin.
Prescribed antiretroviral therapy helps keep a person’s immune system healthy and reduces the incidence and severity of infections and diseases.
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