Reports From the Field

HIV/AIDS

Skin conditions may indicate HIV infection in women

Women are the fastest-growing population at risk for HIV in the United States, and many skin conditions commonly associated with HIV or AIDS that affect women are treated as a single problem rather than an indication for further testing, according to a presentation at the American Academy of Dermatology’s annual meeting in San Francisco.

Dermatologists have observed that common skin conditions such as recurring vaginal yeast infections can be early markers for HIV infection, says M. Joyce Rico, MD, deputy chief of staff at the Veteran’s Affairs New York Harbor Health System and associate professor of dermatology at New York University in New York City. Women who are immune-suppressed often develop severe treatment-resistant vaginal yeast infections with milky white discharge and white patches on the skin, she says, adding that a recent study found that 37% of women with recurrent yeast infections eventually sought care for HIV.

"Too often, patients and their physicians treat a specific incidence of a sexually transmitted disease or yeast infection without looking at the overall pattern of these conditions," notes Rico. "We need to focus on the increasing number of cases of HIV in women and be aware that if a woman has specific recurring problems with certain dermatologic conditions, she may be at risk for HIV."

Some skin conditions occur so frequently in HIV-infected women that they are now considered signs of the disease, she adds. Skin conditions that should lead dermatologists to suggest an HIV test include herpes zoster, or shingles; oral candidiasis, or thrush; oral hairy leukoplakia; and molluscum contagiosum.

"Until recently, there has not been much attention to the relationship between skin conditions and HIV infection in women," explains Rico. "Women and their physicians need to be aware that complacency is part of the tragedy of this epidemic."