Skin And Mouth Problems

The diagnosis of these HIV-related skin and mouth problems usually rests on characteristic clinical features.The tables below show diagnoses and treatments.

Skin problems

° Virus infections

Infection

Local treatment

Drug treatment

Adults Children

Herpes simplex (oral and genital)

Local lesion care

(i.e. regular cleaning and avoiding secondary bacterial infection)

Acyclovir orally 5 times/daily until healed

200 mg

<2 years 100 mg > 2 years 200 mg

Varicella zoster

Local lesion care

(i.e. regular cleaning and avoiding secondary bacterial infection)

Analgesia

Acyclovir

800 mg orally 5 times/daily for at least 7 days

20 mg/kg (max. 800 mg) 4 times/daily for 5 days

Anal/genital warts (human papilloma virus)

Topical 20% podophyllin 1-2 times per week until healed

Trichloracetic acid Cryotherapy

Molluscum contagiosum

Leave the lesions alone OR prick each lesion with a needle or sharpened orange stick and touch with phenol. Trichloracetic acid Cryotherapy

° Fungal infections

Infection

Local treatment

Drug treatment

Adults Children

Tinea (pedis/ corporis/ cruri)

Whitfield's ointment or Castellani's paint

Topical antifungals 1% clotrimazole 2% miconazole

In resistant cases griseofulvin

500 mg orally twice daily

10 mg/kg orally daily in divided doses or as a single dose

Candidiasis

1% aqueous gentian violet or nystatin ointment twice daily until lesions are cleared

Topical antifungals

Cutaneous cryptococcosis/

histoplasmosis

Systemic antifungal therapy

° Bacterial infections

Infection

Local treatment

Drug treatment

Adults Children

Impetigo, furunculosis

Penicillin V orally 4 times daily for 1-2 weeks

500 mg

Up to 1 year 62.5 mg, 1-5 years 125 mg, 6-12 years 250 mg

OR flucloxacillin orally 4 times daily for 1-2 weeks

500 mg

< 2 years quarter adult dose 2-10 years half adult dose

OR Erythromycin orally 4 x daily for 1 - 2 weeks

500 mg

< 2 yearsl25 mg 2-8 years 250 mg > 8 years 250-500 mg

Pyomyositis

Surgical drainage

Plus antibiotics (as for

impetigo)

Bacillary

Erythromycin orally 4 times

angiomatosis

daily for 8 weeks

(due to

500 mg

< 2 yearsl25 mg

Bartonella

2-8 years 250 mg

henselae)

> 8 years

(lesions may

250-500 mg

resemble

Doxycycline orally twice a

Kaposi

day for 8 weeks

Sarcoma

100 mg

Not to be given

-definitive

(Not to be

to children < l2

diagnosis by

given to

years

biopsy)

pregnant or breastfeeding women)

° Other

Condition

Local treatment

Drug treatment

Adults Children

Pruritus without skin lesions

Calamine lotion Antihistamines

Papular folliculitis

(pruritic papular dermatosis;

eosinophilic folliculitis

Calamine lotion

Topical antifungals with 1% hydrocortisone Strong topical corticosteroids

Antihistamines

Metronidazole twice a day for 7-14 days

250 mg

7.5 mg/kg every 8 hours

Seborrhoeic dermatitis

Antifungal shampoos OR topical antifungals with steroids OR topical 1% hydrocortisone Strong topical corticosteroids

If severe, ketoconazole orally

200 mg twice daily

3 mg/kg daily

Ichthyosis (dry scaly skin)

Emollients (e.g. aqueous cream)

Psoriasis

Conventional antipsoriasis treatment, e.g. coal tar in salicylate ointment twice daily

Scabies

Topical benzyl benzoate 25%

Topical lindane lotion

Ivermectin 200 Mg/kg as a single dose with topical drugs

Radiotherapy

Chemotherapy

° Mouth problems

Condition

Local treatment

Drug treatment

Adults Children

Oral candidiasis

Topical antifungals such as amphotericin lozenges, nystatin pastilles/pessaries: nystatin drops I00000 units 3 times daily OR nystatin pessaries one every 4 hours OR nystatin tabs 500000 units 4 times daily. If nystatin not available, use gentian violet 0.25-0.5% In all cases treat for 7-14 days. Recurrence is common without prophylaxis.

In resistant cases oral ketoconazole for 14 days

200 mg twice daily

3 mg/kg daily

As an alternative in resistant cases (except in children under 1 year) fluconazole for 14 days

IGG mg daily

2 mg/kg daily

Hairy leukoplakia

No treatment

Angular cheilitis

Topical antifungals e.g. 1% clotrimazole

Gingivitis/

dental abscesses

Metronidazole orally for 7 days

400 mg 3 times daily

7.S mg/kg every 8 hours

AND/OR penicillin V for 7 days

S00 mg 4

times daily

Up to I year 62.S mg I-S years I2S mg, 6-I2 years 2S0 mg

Aphthous ulcers

Mouth rinses with steroid and tetracycline Topical corticosteroids

Oral prednisolone

Oral acyclovir

(Oral thalidomide 200 mg daily in refractory cases)

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