Clinical Analysis Of HIV/AIDS Patients With Solar Dermatitis

Objectives:To perform a complete descriptive analysis of 33 HIV-positive patients,to study the effects of different UV radiation spectrum in association with CAD and PMLE and to determine clinical differentiation points between HIV-positive and HIV-negative solar dermatitis patients.Materials&Methods:Data of 33 HIV-positive solar dermatosis patients was collected form The First Affiliated Hospital of Kunming Medical University from January 2008 till February 2017.Detailed clinical analysis and case-series of patients was reported.Results:All 33 patients ethnically Han were diagnosed with HIV and solar dermatitis,male to female ratio was 5:1,patients diagnosed with PMLE accounted for 57%,patients diagnosed with CAD accounted for 40%and patient diagnosed with lymphoma accounted for 3%of all cases.Range of known HIV disease was from 6 month to 13 years and the duration of clinical manifestations ranged from 10 days to 10 years.Pruritus with erythema was the most prominent associated condition in recorded cases.Pruritus alone(10 cases),erythema alone(1 case),pruritus with erythema(20 cases),pruritus with vesicles(1 case).Eosinophils were elevated in 2 cases,neutrophils were elevated in 1 case,TPPA,TRUST was positive in 1 case and mycosis examination for oral candidiasis was positive for 2 cases.HIV-negative SD patients were more sensitive towards UVA as compared to HIV-positive SD patients who were more sensitive to UVB(CAD P=0.001&PMLE P=0.027).The CD4,occupation and skin types had no positive association with HIV-related SD,mean CD4 was 218 cell/?l.HAART for HIV and "Regime A&B" were administered to all patients which showed improved SD lesions.Two morphological/clinical picture variants were identified 1)chronic eczema and 2)erythematous/papular dermatosis.CAD and PMLE showed a significant difference in "time of dermatosis formation"(P=0.015),"history/duration of SD"(P=0.029),"clinical picture"(P=0.007)and MED values.Histopathological examination reviled"Hyperkeratosis,acanthosis,parakeratosis,with apoptosis of keratinocytes in the epidermis"as the classical findings of HIV-related Solar dermatitis.Conclusion:Solar dermatitis in HIV-positive individuals appears to be a manifestation of advanced disease,however less severe and acute photoeruptions represent early stages of HIV,whereas severe and chronic photoeruptions represent late stages of HIV disease.CD4 count has non-significant association with HIV-related PMLE or CAD.HIV-positive CAD and PMLE patients showed high sensitivity towards UVB radiation,whereas HIV-negative CAD and PMLE patients showed high sensitivity towards UVA radiation.Disparity between HIV-positive CAD and PMLE exists in,time of dermatosis formation,duration of disease,clinical picture and MED values."Hyperkeratosis,acanthosis,parakeratosis,with apoptosis of keratinocytes in the epidermis" is the classical findings of HIV-related Solar dermatitis.Primary mode of treatment is sun avoidance and selection of treatment regimens depends upon clinical picture of SD.