In people affected by acquired immuno-deficiency syndrome it may often be observed a rise of cutaneous emergencies, whose impact spans from 25% in asyntomatic subjects to 100% in the case of very evident AIDS.

The frequency and the atypic nature of these emergencies gives a highlighted role to the dermatologist, characterizing the early diagnosis of cutaneous pathologies as the qualifying moment in the analysis of AIDS affected patient.

As the starting moment in the HIV-positive subject examination, search for injuries referable to Kaposi's sarcoma, especially at the mucous level (pharinx wounds are evident in 10 to 50% of total cases).

KAPOSI'S SARCOMA is a cutaneous malignant neoplasia. In its early emergence it reveals itself with deep red coloured, inactive maculae, that afterwards take a papulo-nodular look, concerning the whole cutaneous range (face, lower limbs and trunk). Frequent and severe are also the visceral displays (intestine, lungs, spleen and liver).

Afterwards it is necessary to seek for the other dermatological frames that are more frequently associatd with HIV infection.

SEBORRHEIC DERMATITIS ( 83% of AIDS bearers ) appears very frequently since beginning of the disease. Erytemato-scaly injuries, localized on the scalp, on the face ( eyebrows, nose-genial groves, retroauricolar area ) and in the pre-sternal and infra-scapular areas, are characterisic.

Atypic displays affecting the lower limbs (folliculitis) are present, along with scattered ( erytrodermic ) displays. Seborrhea is intense. In HIV-positive subjects, the persistence and the importance of the morbid situation may suggest an unhappy prognosis. VILLOUS ORAL LEUKOPLAKIA pops up in 20% of AIDS patients.

A peculiar importance seems imputable to the association of papilloma virus, Epstein-Barr virus and Candida. It shows as whitish, rising and papillomatic spots, located on the lateral and ventral edges of the tongue. Such a frame denotes a negative prognosis.

The infection originated by HERPES SIMPLEX either type-1 that is responsable for non genital injuries, than type-2 causing genital injuries, in HIV subjects appears to be of high relevance, in extension and duration aspects. It affects more frequently the peri-orificial areas. In these subject, the classical cluster-shaped vescicular injuries show as ulcerative and painful hurts. Herpes simplex may show in scattered form ( Kaposi chicken-pox-like eruption ).

HERPES ZOSTER may, in HIV-positive subiects, show cutaneous frames of special extension, afflicting simultaneously various metamera with necrotic hemorragic aspect. It may undertake a chronic course, with new eruptions and delayed resolution of the existing ones.

CHICKEN-POX, in HIV-positive subiects, is more serious and longer lasting. Hurts are vescicula-blisters that reach the usually aved locations ( palm-sole areas ). Also frequent is the visceral involvement, giving in these cases a 30% lethality factor.

CANDIDOSIS is more frequent and of peculiar seriousness. They may show cutaneous, mucous or visceral displays. The more common localization is the oral area, but often intertrigo,folliculitis, vaginitis and onychopaties are found.

FLAT and ORDINARY WARTS and POINTED CONDYLOMA are cutaneous affections feeded by papilloma virus, they appear to be multiple, remarkably sized and recurring.

CONTAGIOUS MOLLUSK is a pox-virus originated infection. It shows itself with multiple injuries, especially at the external genitalia and at the face lvel, aiming to rech big sizes.

CYTOMEGALOVIRUS originated infection, caused by a virus pertaining to the herpes virus group, is usually the re-activation of a children's infection. It may induce either a simil-nucleosic syndrome, with fever, myalgiae, short-lasting cutaneous rush, or a scattered form, with early cutaneous hurts and ulcerations in the anal mucose and in the peri-anal cutis, followed by the involvement of perineum, buttocks and thighs and further diffusion to the internal organs. Injuries may also appear as nodules, hyperpigmented spots, diffused hexanthema and vesciculo-blistery hurts.

CRYPTOCOCCOSIS is an infection originated by criptococcus neoformans. The cutaneous displays stands for a rare appearance of the disease and joins with a systemic concern. Injuries are red-bluish. inactive nodules that ulcerate, or acne-like papulo-pimples.

HISTOPLASMOSIS caused by Istoplasma capsulatum, leads to a pulmonary granulomatic disease. Its cutaneous involvement is rare and is referred the growth of nodules, inclining to ulcerate.

COCCIDIOMICOSIS, feeded by coccidioides immitis, may show three clinical displays: I)knotty erythema type II)inactive subcutaneous abscessa III)inactive ulcerative cutaneous injuries.

CUTANEOUS BACTERIAL INFECTIONS include various pyodermae (folliculitis, boils and abscesses), mainly attributable to staphilococcus aureus-A and G group, to streptococcus and to pseudomonas aeruginosa. They are more frequent in drug addicts.

B-CELLS LYNPHOMAE are the more recurring in HIV-positive subjects.

VASCULITIS may result from immunocomplexes with the tipical palpable purpura, or from thrombocytopenia, almost constant during AIDS, with petechia and purpura. Multiple nail-bed hemorragiae and ear multiple angioma are also noticed.

PSORIASIS may pop up in an acute way, in HIV-positive subjects, assuming atypical forms, with an heawy, eruptive often itching course and pimply aspect.Psoriasic onychopathye is frequently reported.

Last but not least, is the AIDS very evident aspect, CUTANEOUS DISTROPHIC-DEFICIENT DISPLAYS are found, as widespread alopecia, early turning white, widespread ichthyosis and premature aging.

Prof. Camillo O. Di Cicco, MD. Presented to "II International Spring Symposium European Academy of Dermatology and Venereology, Budapest". Published in Journal of European Academy of Dermatology and Venereology, Volume 18, Supplement 1.

Presented to Serono Symposia International, April 2-3, 2004 Los Angeles, California, USA.