HIV/AIDS and Dermatological Findings at A Glance: What Has Changed in the ART Era.

The prevalence of skin diseases and sexually transmitted diseases has always played a special role in studying HIV infections, both because of immunosuppression and simultaneous transmission. In the early years of the HIV epidemic, skin diseases were often a pathognomonic sign in heavily immunosuppressed patients. With highly active antiretroviral therapy (HAART), HIV infection has become a treatable chronic disease. For this reason the spectrum as well as the prevalence of skin diseases has changed. Pathognomonic skin diseases have become rare and the wide spectrum today ranges from infectious to iatrogenic skin diseases. From April to October 2007 166 HIV-infected patients and 173 patients of a comparison group were surveyed in retrospect by means of a questionnaire about skin diseases and sexually transmitted diseases that appeared over the entire year 2006. The study confirmed the shift to a wide variety of mostly trivial skin diseases and away from severe opportunistic skin diseases. HIV-infected patients today have more numerous skin problems than the non-infected population and thus need regular dermatologic control examinations.

Dermatological conditions are more prevalent and often refractory to treatment in those living with HIV, particularly when the CD4 lymphocyte subset count is low. Some studies suggest that the prevalence of skin diseases may be as high as 92% in HIV-infected individuals. 1 These include seborrhoeic dermatitis, infective dermatoses, drug reactions and cutaneous malignancies including Kaposi's sarcoma. In many European countries, dermatology and venerology are a combined specialty, although this is not the case in others, including the UK, in which there are separate training programmes. Genito-urinary medicine specialists in these countries will therefore not have ample dermatological training, with dermatologists presently providing expertise and support in recognizing and managing complex skin conditions. We have examined the prevalence of dermatological conditions in HIV-infected individuals admitted to hospital. All eligible in-patients with HIV infection admitted to Chelsea and Westminster Hospital between December 2014 and February 2015 were offered a full dermatological examination. Data on patient demographics, HIV metrics and comorbidities were collected, including previous dermatological diagnoses. Documentation of dermatological examination by the admitting (HIV) team was noted and compared with a specialist dermatology opinion. In total, 50 patients were included and examined as part of the study. Of these, nine (18%) were female and 41 (82%) male. The mean age was 47 years (range 20–75 years), and the median CD4 lymphocyte subset count was 394 cells/μL (range 26–1093 cells/μL). Fourteen (28%) were not receiving antiretrovirals. Of the 50 patients, 12 (24%) had a previous dermatological diagnosis. Reasons for admission to hospital included investigation and management of infective conditions (such as pneumonia, meningitis and pyelonephritis), haemoptysis, new neurological signs, seizures, stroke, treatment of malignancy (lymphoma) and anaemia. With regard to the admission clerking, only 13 patients (26%) had documentation of a dermatological examination, and in six of these patients the documentation stated that there were no cutaneous abnormalities. Examination by a specialist dermatologist revealed cutaneous abnormalities in 34 patients (68%) newly identified during this study. We found that a large proportion of patients had dermatological findings, including inflammatory and infective dermatoses and neoplasia (Kaposi's sarcoma) not identified prior to examination by a dermatologist. In total, 34 (68%) of the patients that we examined had a dermatological finding (Table 1). An alteration in management was instigated in 16 cases (32%). This included undertaking three skin biopsies, administration of new medications in 15 cases, and investigations for microbiology and mycology. While most patients could be investigated and managed promptly, four patients with contact dermatitis and vulval pruritus required onward referral to dermatological subspecialties, and two patients were referred for follow-up in a specialist HIV dermatology clinic; one patient with pruritic papular eruption of HIV and another with nodular prurigo. This study reinforces the requirement for a close working relationship between genito-urinary medicine and dermatology. With the increasing suggestion for dermatology to be provided in the community rather than in secondary care, it also highlights the need for an onsite dermatological presence in the hospital environment, particularly to provide expertise needed for complex cases such as those in individuals living with HIV disease and to support other specialties.

Among HIV-infected individuals, skin diseases cause significant morbidity and are frequently the initial indication of immunosuppression. From an on-going cohort study to determine prevalence and incidence of HIV infection among police officers (POs) and their suitability for HIV vaccine trials, a sub-study was carried out to determine the prevalence and pattern of skin diseases among HIV-infected POs and relate this to their immunodeficiency status. Consenting HIV-infected POs and their age and sex-matched HIV-negative officers were assessed for presence and type of skin diseases at their workplaces. A questionnaire was used for data collection. Immunodeficiency was measured by plasma CD4+ lymphocytes using flow cytometry. Between November 1998 and 31 December 2000, 716 POs were assessed. Overall HIV-1 prevalence was 17.7% (127/716). One hundred and ninety-one POs (26.7%) had at least one skin diagnosis. HIV-infected POs had significantly higher (41.7%) prevalence of skin diseases than HIV-uninfected POs (26.4%), P = 0.002. Fungal infections were common in both HIV-infected and uninfected POs. Among the HIV infected, other common diseases were: herpes zoster (11.8%); pruritic papular eruption (PPE) (7.1%); seborrheic dermatitis (5.5%); and Kaposi's sarcoma (KS) (1.6%). KS and PPE were associated with severe immunodeficiency, with mean absolute (percentage) CD4+ counts of 75.5 cells/microL (4.0%) and 71.7 cells/microL (4.8%), respectively. The values for herpes zoster and seborrheic dermatitis were 271.1 cells/micronL (12.4%) and 206.3 cells/microL (11.3%), respectively. Skin diseases were common among HIV-infected POs. PPE and KS are markers of severe immunodeficiency due to HIV. PPE, herpes zoster and KS strongly suggest underlying HIV-related immunodeficiency and patients with these conditions should be counselled and tested for HIV.

The Pattern of Skin Diseases in Hail Region, Saudi Arabia

Guidelines of care for dermatologic conditions in patients infected with HIV

Background:The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM.Methods:We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated.Results:In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. The duration of T2DM also significantly associated with the prevalence of “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. Subsequently, the prevalence of “disturbances of pigmentation” was higher in males than females in NGT (P < 0.01) and T2DM (P < 0.01) groups. In addition, the difference in the prevalence of “disturbances of pigmentation” was also significant in NGT and T2DM groups (P < 0.01).Conclusions:There was a high prevalence of skin diseases in the Da Qing Diabetes Study. To address the skin diseases in the Da Qing Diabetes Study, increased awareness and intervention measures should be implemented.

Background and objectives: Skin diseases in developing world have stimulated a lot of interest over the years because they are potentially preventable and controllable and because skin diseases also serve as an index of community development. The present study was designed to determine the burden of the skin diseases in rural areas of Erbil governorate. Methods: The study is a community based conducted in one of the rural areas of Erbil study, house to house survey method was applied and all the households were examined after explaining for them the process. Data regarding socio-demographic variables were collected from each family by a specially designed questionnaire. All the household members were clinically examined and the dermatological findings were recorded. Results: The study population composed of 542 persons, 262 (48.33%) male and 280 (51.67%) female with male to female ratio 0.94:1. The overall prevalence of skin diseases was 36.3%, 164 (30.2%) of them affected with one disease, and 33 (6.1%) affected with two diseases. Infectious dermatoses have the highest prevalence rate (20.1%), followed by eczematous skin diseases (10.2%). The overall prevalence of skin diseases was higher among females than males; the prevalence of skin diseases was increasing with rising crowding index. Conclusion: The study concluded that the prevalence of skin diseases in rural areas of Erbil governorate is one of the great public health problems that have a significant burden on the population. So, increased public and professional awareness of dermatological care might decrease the size of these disorders and its burden in the community.

Background: Epidemiological data are important for planning medical care. Thus far, only few prevalence data for skin diseases have been published in Germany, most of them not population based. Objectives: Estimation of prevalences of common skin diseases in a sample of employees of German companies. Methods: Whole-body examinations were performed by trained dermatologists in 150 companies as part of skin cancer screenings. Using a standardized and computerized data entry, all clinical dermatological findings were documented. Explicitly skin lesions requiring current treatment were noted. The retrospective evaluation of the data was descriptive, using the diagnoses defined a priori in the data entry mask. Results: 48,665 persons (52.8% male) with a mean age of 43.2 years were examined. The following frequencies of chronic and acute inflammatory skin diseases were observed: contact eczema 8.9%, acne 4.2%, seborrhoeic eczema 3.4%, rosacea 2.2%, psoriasis vulgaris 2.1%, atopic eczema 1.4% and lichen ruber 0.07%. In total, dermatological findings needing treatment were observed in 19% of the study cohort; 1.3% of the participants presented a suspicious finding requiring diagnostics for skin malignoma. Conclusions: There is a high frequency of chronic inflammatory skin diseases in the general working population and a high need for dermatological treatment.

Skin diseases have great socio-economic importance in Germany due to their high and in some cases still-increasing prevalence. Little attention has yet been paid to the influence of the change in climate on these diseases. Clarify the evidence of the effects of climate change on the prevalence of skin diseases and allergies in Germany. First, a theoretical model of the possible mechanisms and influence factors of climate and weather was created for different disease groups (skin malignancies, allergies, skin infections). Then, a systematic online and manual literature search was made for model-derived key words.The relevant publications were selected and evaluated according to a priori criteria. From a total of n = 31,221 hits, n = 320 publications remained for evaluation.Changes in the following parameters can be regarded as essential climatologic factors influencing the prevalence of skin and allergic diseases: temperature, UV radiation, precipitation/humidity, cloudiness, and general weather conditions.There were only a few original articles addressed to this topic. Most of them address recurring phenomena (especially levels of airborne pollen), UV radiation or ozone (and the ozone hole). Quantitative statements, prognosis models and climate scenarios have not yet been published for Germany with respect to skin diseases. Only few scientific articles on the relationship between climate changes and the prevalence of skin diseases have been published. They do not allow a reliable statement on future developments. The outlook for changes in prevalence requires further clarification using published climate models.

Objective To investigate the prevalence of skin diseases in pre-school children aged 0 - 7 years in cities of China. Methods From November 2014 to April 2015, 12 cities were chosen as survey spots, and pre-school children aged 0 - 7 years served as respondents. A population-based study was conducted, and 40 vaccination clinics and 80 kindergartens were selected by stratified random sampling. A questionnaire survey and dermatological examination were performed by trained dermatologists. Results A total of 20 033 pre-school children received questionnaires, whose age was 2.41 ± 1.82 years (range, 0.08-6.83 years) . Among these respondents, 7 823 children were found to have skin diseases, with the total prevalence of skin diseases being 39.05% (7 823/20 033) . Additionally, the prevalence of skin diseases reported in the 12 cities from high to low was as follows: 66.96% (612/914, Dalian) , 56.73% (2 310/4 072, Shanghai) , 55.49% (556/1 002, Wuhan) , 49.18% (390/793, Taiyuan) , 47.16% (316/670, Chengdu) , 41.93% (566/1 350, Nanjing) , 41.03% (318/775, Chongqing) , 35.98% (240/667, Hefei) , 33.87% (677/1 999, Shenzhen) , 31.37% (554/1 766, Changsha) , 23.52% (1 107/4 706, Beijing) , 13.42% (177/1 319, Shenyang) . Totally, 40 kinds of skin diseases were investigated, and the 10 most common skin diseases were eczema/infantile eczema/atopic dermatitis (18.71%, 3 749/20 033) , ichthyosis vulgaris (6.25%, 1 253/20 033) , lichen pilaris (5.73%, 1 148/20 033) , diaper dermatitis (5.29%, 1 059/20 033) , papular urticaria (5.25%, 1 052/20 033) , hemangioma/vascular malformation (3.86%, 774/20 033) , pityriasis alba (3.45%, 691/20 033) , infectious skin diseases (2.59%, 519/20 033) , urticaria (1.71%, 344/20 033) and contact dermatitis (0.5%, 100/20 033) . Conclusion The total prevalence of skin diseases among pre-school children in cities of China is 39.05%, and eczema/atopic dermatitis is the most common skin disease. Key words: Child, preschool; Skin diseases; Cross-sectional studies

Introduction: In HIV infected children, skin disorders are important as they serve as clue to diagnosis of the HIV disease. The Skin is one of the early systems affected by HIV/AIDS, which can affect almost all organs and systems in the body. Prevalence of skin disorders among HIV infected children is up to 90% in some studies. Objective: To determine the prevalence of skin disorders among HIV infected children attending paediatric infectious disease clinic in Aminu Kano Teaching Hospital Kano, Nigeria. Materials and Methods: A cross-sectional study was conducted to determine the prevalence of skin manifestations among HIV infected children attending paediatric infectious disease clinic of Aminu Kano Teaching Hospital, Kano, Nigeria. A total of 223 HIV infected participants aged 6weeks to14 years were recruited for this study. Results: The prevalence of skin disorders among HIV infected children was 78.0%. The leading categories were infections and infestations accounting for 55.1% then inflammatory skin disorders (20.6%) Dermatophytoses were the commonest specific skin disorders observed. Conclusion: Therefore, the prevalence of skin disorder among HIV infected children in Aminu Kano Teaching Hospital is high (78%). Infections and infestations were the commonest category found followed by inflammatory skin disorders.

Background: Skin diseases are common among children in the developing countries in Sub Saharan Africa where there is low level of hygiene, overcrowding and warm humid climates. However, there are no known community based studies on the prevalence of skin diseases among primary school children in Rivers State, Nigeria. This study aimed to determine the prevalence and types of skin diseases among primary school children in three semi urban communities in ObioAkpor LGA in Rivers State, Nigeria.&#x0D; Materials and Methods: This descriptive, cross sectional study was conducted in five public primary schools in three semi urban communities in ObioAkpor LGA over a three months period from September to November 2017. Five hundred and twenty four children were recruited for the study from the selected schools. Interviewer administered questionnaire was used to obtain information on socio-demographics and a team of investigators examined each child for evidence of skin diseases.&#x0D; Results: There were 263 (50.2%) males and 261 (49.8%) females, with male to female ratio of 1.01: 1. Their ages ranged between 5 to 16 years, with a mean age of 9.5±2.22 years. The prevalence of skin lesions among the children was 35.3% (185/524). Skin infections, inflammatory dermatitis and other skin lesions accounted for 39.5%, 14.1% and 46.5% respectively of the skin diseases. The most prevalent specific skin disease found was Dermatophyte infection in 50 (27.0%) children, followed by Xerosis 21 (11.4%). Tinea capitis was the most common (52.1%) skin infection. The commonest inflammatory dermatitis found was Seborrheic dermatitis 53.8%. Age had no significant influence on the prevalence of skin infections (p=0.711).&#x0D; Conclusion: The prevalence of skin diseases was high among primary school children in the semi urban communities in ObioAkpor LGA and Dermatophyte infection accounted for more than a quarter of the skin diseases found. Maybe regular inspection of the skin of primary school children by health professionals and teachers should be done in order to reduce the spread of infectious skin diseases within the schools.

A cross sectional study was carried out during the period between November, 2013 to April, 2014 to determine the prevalence of major skin disease and to identify the dominant risk factors for this disease in Gondar university veterinary clinic. A total of 1296 ruminants that came to the Clinic were involved in the study. Out of this 513(39.6%) cattle, 631(48.7%) sheep and 152(11.7%) goat was included. Skin scraping, morphological identification and clinical presentation were the methods employed for identification of mange mites and Dermatophilosis, gross ectoparasites and viral skin disease respectively. 468(36.1%) were infested with one or more skin diseases. The prevalence of skin diseases in cattle, sheep and goats were 142(27.68%), 268(42.47%) and 58(38.12%) respectively. The difference in the prevalence of skin diseases among the three host species was statistically significant (p<0.05). The major skin diseases identified on ruminants were tick 116(8.95%), mange 31(2.39%), lice 91(7.02%), sheep ked 72(5.56%), lumpy skin disease 29(2.24%), Dermatophilosis 9(0.69%), orf 45 (3.47%) and sheep and goat pox 77(5.94%).The prevalences of ectoparasites at genus level were tick (BoophilusHyalomma, Amblyommaand Rhipicephalus), mange mite (Demodex, Sarcoptesand Psoroptes) and Lice (Damalina and Linognathus). The difference in the prevalence of skin disease infestation between poor and good body condition was statistically significant in ruminants (P<0.001).The predilation site of skin disease were tick in hairless area, mange mite and lice in neck and head areas, Dermatophilosis on the back, orf in face region of, sheep ked in hairy parts of sheep, lumpy skin disease and sheep and goat pox in whole body parts of cattle and small ruminants. The study demonstrates that skin disease is among the most important health constraints of ruminants in and around Gondar town, hence requires immediate attention and control interventions.

This study was conducted to clarify the prevalence of common skin diseases and their associated factors among military personnel in Korea. Four dermatologists visited adjacent military units and examined soldiers. A structured questionnaire that included questions about known skin diseases, demographic information, and questions for the Perceived Stress Index was completed for each participant. The soldiers that had been diagnosed with a skin disease answered one additional questionnaire (Skindex-29) which assess the influence of an individual's skin disease on daily life. Of 1,321 soldiers examined, 798 (60.4%) had one or more skin diseases. The three most common skin problems were acne (35.6%), tinea pedis (15.2%) and atopic dermatitis (5.1%). The diseases closely related to the period of military service were acne, tinea pedis, viral warts and corns. The diseases related to the amount of stress were atopic dermatitis, seborrheic dermatitis, and acne. The most troublesome skin diseases were atopic dermatitis, tinea cruris, and seborrheic dermatitis. These results demonstrated that the prevalence of skin disease among military personnel in Korea is very high, and that some of the skin disorders may have a significant influence on their daily lives.

A crossectional study was carried out during the period between November, 2013 to April, 2014 to determine the prevalence of major skin disease and to identify the dominant risk factors for this disease in Gondar university veterinary clinic. A total of 1296 ruminants that came to the Clinic were involved in the study. Out of this 513 (39.6%) cattle, 631 (48.7%) sheep and 152 (11.7%) goat was included. Skin scraping, morphological identification and clinical presentation were the methods employed for identification of mange mites and Dermatophilosis, gross ectoparasites and viral skin disease respectively. 468 (36.1%) were infested with one or more skin diseases. The prevalence of skin diseases in cattle, sheep and goats were 142 (27.68%), 268 (42.47%) and 58 (38.12%) respectively. The difference in the prevalence of skin diseases among the three host species was statistically significant (p <0.05). The major skin diseases identified on ruminants were tick 116 (8.95%), mange 31 (2.39%), lice 91 (7.02%), sheep ked 72 (5.56%), lumpy skin disease 29 (2.24%), Dermatophilosis 9 (0.69%), orf 45 (3.47%) and sheep and goat pox 77 (5.94%). The study demonstrates that skin disease is among the most important health constraints of ruminants in and around Gondar town, hence requires immediate attention and control interventions.