When they mess up

Skin complaints particularly rashes are a common problem for people with HIV. Skin ailments can either be the result of opportunistic infections or side effects of medications.

 

A red, blotchy, itchy rash over the whole body, which starts few days after starting a new treatment, is most likely an allergy to the medication. A severe allergic rash may be accompanied by fevers and sores in the mouth.

Nevirapine, an anti-retroviral drug, causes rash in 16 percent of people who start the drug. Antibiotics such as penicillin and cotrimoxazole can also cause rashes.

Infections commonly associated with rashes include herpes simplex, syphilis, herpes zoster (shingles) and Molluscum contagiosum.

Shingles is a painful skin disease. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash and blisters that look like chickenpox.

The name shingles comes from the Latin word cingulum, which means ‘belt’ or ‘girdle’. Shingles is caused by a germ called varicella-zoster virus (VZV)—the same virus that causes chickenpox. Once infected with this kind of virus, it remains in the body for life. It stays inactive until when immunity is down.

VZV is common in the population and can be transmitted by inhaling virus from the breath of infected people or from direct contact with infectious lesions. Many people become infected with it as children when it causes mild chickenpox. People with HIV, who have not had chickenpox, are advised to stay away from children with chickenpox to avoid becoming infected. Conversely, a person with shingles is able to infect a child or someone else who has not had chickenpox.

The pain of shingles can be debilitating. It can be severe and persist for months or years. The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression. In people with HIV, the rash can be much more extensive than usual and the illness can be complicated by pneumonia.

Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the eye is affected. Bacterial infection of the open sores can lead to scarring. In a very small number of cases, bacteria can cause more serious conditions.

Treatment of rashes depends on the cause. If it is an allergy to drugs, if severe, the drug may be discontinued or other drugs prescribed to treat the allergy.

The shingles virus can be treated with antiviral medication. Painkillers can relieve the pain, while calamine lotion should help to reduce the itching.