[HIV-associated dermatoses and their prevalence in 456 HIV-infected patients. Relation to immune status and its importance as a diagnostic marker].

Some 456 patients with HIV-associated skin disorders were documented in the HIV follow-up clinics at the Department of Dermatology, University Medical Center Steglitz, Berlin, during the years 1982-1992. Males comprised 91% of the patients. The most important risk groups for HIV infection were homosexual and bisexual men (77.9%) and individuals with intravenous drug abuse (12.7%). The most frequent dermatological diagnoses were oral candidosis (44.5%), seborrhoeic dermatitis (38.6%), folliculitis (32.9%) and Kaposi's sarcoma (23.5%). Altogether, 138 of the patients died during the time of observation. The most frequent cause of death was disseminated Kaposi's sarcoma (26.8%). A significant proportion of the patients developed skin diseases before significant reduction of the circulating CD4+ lymphocytes. In a still satisfactory immune situation, predominantly infections of the skin with dermatophytes (tinea), human papilloma viruses (warts) and bacteria (pyodermas) were observed. A considerable number of the HIV patients who developed zoster were also still in a favourable immune status; another 50% of these cases, however, developed the disease with reduced CD4+ lymphocyte count (< 300/microliters). Skin manifestations that tended to occur later in the course of HIV infection were oral candidosis, oral hairy leukoplakia, herpes genitoanalis, mollusca contagiosa and Kaposi's sarcoma, in spite of their early appearance in some cases. In the large majority of these patients the immunological parameters were already clearly reduced. Fungal, bacterial and viral infections of the skin, especially with extended skin involvement, may manifest themselves during the early phases of HIV infection. The number and severity of the skin manifestations increase with progressing immunosuppression, and treatment is often a difficult challenge for the dermatologist.