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close this bookTB/HIV: a Clinical Manual (WHO - OMS, 1996, 135 p.)
close this folderChapter 10 - Management of other HIV-related diseases in TB/HIV patients
View the document10.1 Introduction
Open this folder and view contents10.2 Sexually transmitted diseases
View the document10.3 Skin and mouth problems
Open this folder and view contents10.4 Gastrointestinal problems
View the document10.5 Respiratory problems
Open this folder and view contents10.6 Neurological problems
Open this folder and view contents10.7 Fever
View the document10.8 Other HIV-related problems which may occur in TB/HIV patients

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.

DIAGNOSIS

TREATMENT

SKIN PROBLEMS


· VIRUS INFECTIONS


Herpes simplex (oral and genital)

Local lesion care.


Acyclovir 200 mg five limes daily until healed.

Varicella zoster

Local lesion care.


Acyclovir 800 mg po 5x/day for at least 7 days.

Anal/genital warts (human papilloma virus)

Topical 20% podophyllin 1 -2 times per week until cleared.


Trichloracetic acid.


Cryotherapy.

Molluscum contagiosum

Leave the lesions alone OR


Prick each lesion with a needle or sharpened orange stick and touch with phenol.

· FUNGAL INFECTIONS


Tinea (pedis/corporis/cruris)

Whitfield’s ointment or Castellani’s paint


Topical antifungals.


1 % Clotrimazole.


2% Miconazole.


In resistant cases use griseofulvin 500 mg 2x daily.

Candidiasis

Local application of 1 % aqueous gentian violet or nystatin ointment 2 x daily until lesions are cleared.


Topical antifungals.

Cutaneous cryptococcosis/histoplasmosis

Systemic antifungal therapy.

· BACTERIAL INFECTIONS


Impetigo, furunculosis

Penicillin V 500 mg orally OR


Flucloxacillin or erythromycin 500 mg orally 4 x daily for 1 - 2 weeks

Pyomyositis

Surgical drainage plus antibiotics (as for impetigo)

· OTHER

Papular folliculitis (pruritic papular dermatosis)

Calamine lotion.


Antihistamines.


Topical antifungals combined with 1 % hydrocortisone.


Strong topical corticosteroids.

Seborrhoeic dermatitis

Antifungal shampoos OR topical antifungals with steroids OR topical 1% hydrocortisone.


Strong topical corticosteroids.

Psoriasis

Conventional antipsoriasis treatment, eg coal tar in salicylate ointment 2 x daily.

Scabies

Topical benzyl benzoate 25%

Kaposi’s Sarcoma

Local lesion care.


Radiotherapy, chemotherapy.

MOUTH PROBLEMS

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.


In resistant cases oral ketoconazole 200 mg 2 x daily.


In all cases treat for 7 - 14 days.


Recurrence is common without prophylaxis.

Hairy leukoplakia

No treatment.

Angular cheilitis

Topical antifungals eg 1 % clotrimazole.

Gingivitis dental abscesses

Oral metronidazole 400 mg 3 x daily and/or penicillin V 500 mg 4 x daily for 7 days.

Aphthous ulcers

Mouth rinses with steroid and tetracycline.


Topical corticosteroids.


Oral prednisolone.


Oral acycloivir.
(Oral thalidomide in refractory cases).