 | TB/HIV: a Clinical Manual (WHO - OMS, 1996, 135 p.) |
 |  | Chapter 10 - Management of other HIV-related diseases in TB/HIV patients |
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10.3 Skin and mouth problems
The diagnosis of these HIV-related skin and mouth problems usually rests on characteristic clinical features. The tables show diagnoses and treatments.
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DIAGNOSIS |
TREATMENT |
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SKIN PROBLEMS |
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· VIRUS INFECTIONS | |
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Herpes simplex (oral and genital) |
Local lesion care. |
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Acyclovir 200 mg five limes daily until healed. |
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Varicella zoster |
Local lesion care. |
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Acyclovir 800 mg po 5x/day for at least 7 days. |
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Anal/genital warts (human papilloma virus) |
Topical 20% podophyllin 1 -2 times per week until cleared. |
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Trichloracetic acid. |
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Cryotherapy. |
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Molluscum contagiosum |
Leave the lesions alone OR |
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Prick each lesion with a needle or sharpened orange stick and touch with phenol. |
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· FUNGAL INFECTIONS | |
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Tinea (pedis/corporis/cruris) |
Whitfield’s ointment or Castellani’s paint |
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Topical antifungals. |
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1 % Clotrimazole. |
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2% Miconazole. |
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In resistant cases use griseofulvin 500 mg 2x daily. |
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Candidiasis |
Local application of 1 % aqueous gentian violet or nystatin ointment 2 x daily until lesions are cleared. |
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Topical antifungals. |
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Cutaneous cryptococcosis/histoplasmosis |
Systemic antifungal therapy. |
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· BACTERIAL INFECTIONS | |
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Impetigo, furunculosis |
Penicillin V 500 mg orally OR |
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Flucloxacillin or erythromycin 500 mg orally 4 x daily for 1 - 2 weeks |
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Pyomyositis |
Surgical drainage plus antibiotics (as for impetigo) |
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· OTHER |
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Papular folliculitis (pruritic papular dermatosis) |
Calamine lotion. |
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Antihistamines. |
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Topical antifungals combined with 1 % hydrocortisone. |
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Strong topical corticosteroids. |
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Seborrhoeic dermatitis |
Antifungal shampoos OR topical antifungals with steroids OR topical 1% hydrocortisone. |
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Strong topical corticosteroids. |
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Psoriasis |
Conventional antipsoriasis treatment, eg coal tar in salicylate ointment 2 x daily. |
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Scabies |
Topical benzyl benzoate 25% |
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Kaposi’s Sarcoma |
Local lesion care. |
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Radiotherapy, chemotherapy. |
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MOUTH PROBLEMS | |
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Oral candidiasis |
Topical antifungals such as amphotericin lozenges, nystatin pastilles/pessaries: nystatin drops 100,000 units 3 x daily OR nystatin pessaries one every 4 hours OR nystatin tabs 500,000 units 4 x daily. |
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In resistant cases oral ketoconazole 200 mg 2 x daily. |
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In all cases treat for 7 - 14 days. |
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Recurrence is common without prophylaxis. |
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Hairy leukoplakia |
No treatment. |
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Angular cheilitis |
Topical antifungals eg 1 % clotrimazole. |
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Gingivitis dental abscesses |
Oral metronidazole 400 mg 3 x daily and/or penicillin V 500 mg 4 x daily for 7 days. |
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Aphthous ulcers |
Mouth rinses with steroid and tetracycline. |
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Topical corticosteroids. |
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Oral prednisolone. |
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Oral acycloivir. |
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