Skin disorders affecting human immunodeficiency virus-infected children living in an orphanage in Ethiopia

Abstract

SummaryBackground. Skin disorders are common in children in Ethiopia, and it is estimated that 92 000 Ethiopian children are infected with human immunodeficiency virus (HIV). HIV infection increases the prevalence of cutaneous disease, but the effect of antiretroviral therapy (ART) on the pattern of skin disease affecting children in subSaharan Africa (SSA) is unclear. Aim. To assess the prevalence and nature of skin disorders in HIV-infected children living in a dedicated orphanage in Addis Ababa, Ethiopia. Methods. Two dermatologists performed a clinical examination, including the skin, hair, nails and oral cavity of all the residents of an orphanage in Addis Ababa. The examiners knew that all the children were infected with HIV, but did not know their treatment or immune status. Diagnoses were made clinically and recorded anonymously, and treatment recommendations were made. Details of the children's treatment and CD4 lymphocyte counts were obtained after the examination had been completed. Results. In total, 84 children [53 male (63%); 31 female (37%); median age 10 years] were examined. Of the 84 children, 57 (68%) were on ART, with 51 (61%) of these on cotrimoxazole prophylaxis. The median CD4 percentage was 27.1%. There were 66 children (79%) with at least one skin disorder; 21 of these had two disorders and 6 had three disorders. The commonest diagnosis was tinea capitis, affecting 39% of children. The other common diagnoses were: molluscum contagiosum (MC) (21%), verruca vulgaris (13%), plane warts (8%) and seborrhoeic dermatitis (7%). There was no significant difference in the prevalence of skin disease between children receiving ART and those who were not. Children with MC had significantly lower recent CD4 counts than children who did not have skin disease. Conclusions. Skin disorders in this population were very common, and the disorders identified were those that commonly affect children without HIV in Ethiopia. However, MC and plane warts appeared to have a higher frequency than would be expected in uninfected children.

Mucocutaneous manifestations of human immunodeficiency virus (HIV) infection in children in relation to the degree of immunosuppression

“…It was seen in 17 (10%) patients, the incidence being 11% in the normal CD4 category, 9% in the mild, and 14% in the advanced category of immunosuppression. This was in accordance with studies done by Wananukul et al., Umoru et al., and Doni et al . In our study, multiple lesions of MC (>20) were seen in three patients who belonged to the normal CD4 category.…”

“…In conclusion, the commonest condition may vary in different parts of the world. In the Indian subcontinent, PPE was found to be the commonest condition while in Africa, conditions such as oral candidiasis, T. capitis, and plane warts were the predominant conditions. Our study was conspicuous for the absence of infectious conditions such as candidiasis and seborrheic dermatitis.…”

“…In past studies worldwide, commonest conditions were infections such as oral candidiasis, T. capitis, and plane warts . In a study on 65 children in India, pruritic papular eruption (PPE) was seen in 19 children (29.23%) and was the most common condition .…”

“…There was no significant difference in the percentage of manifestations between those who were on ART (59%) and those who were not (63%). In the study by Doni et al., there was no significant difference in the prevalence of skin disease between children receiving ART and those who were not . In the study by Lowe et al., they concluded that 32% of the study participants who were receiving ART at the time of recruitment into the study were diagnosed to have skin diseases within a median time of 5 months, which was attributed to immune reconstitution inflammatory syndrome (IRIS) …”

Orale und Nagelpigmentierungen: eine für den Kliniker nützliche Parallelität

“…Longitudinale oder totale Melanonychie, die gelegentlich mit einer Hyperpigmentierung der Haut einhergeht, ist eine häufige Nebenwirkung einer Hydroxyharnstoffbehandlung bei Kindern und tritt der Literatur zufolge bei bis zu 10 % der Kinder mit Thalassämie auf, die dieses Arzneimittel erhalten [25,26]. Die NP wird in seltenen Fällen auch bei Patienten beobachtet, die mit Minocyclin, Zidovudin (bei bis zu 5 % der Kinder mit HIV, die Zidovudin erhalten [27][28][29]), Malariamitteln oder Krebs-Chemotherapeutika Abbildung 1 Klinisches (a) und dermatoskopisches Erscheinungsbild der Melanonychie an den Fingernägeln nach Chemotherapie (b, c). Klinisches Erscheinungsbild der oralen Pigmentierung nach einer Hydroxychloroquin-Behandlung (d).…”