Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults

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Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults

Recommendations

In HIV-infected adults, adolescents and children diagnosed with mild/moderate Kaposi sarcoma, immediate ART initiation is recommended.

In HIV-infected adults, adolescents and children diagnosed with severe symptomatic Kaposi sarcoma, immediate ART initiation in combination with systemic chemotherapy is recommended.

HIV-infected children and adults with mild seborrhoeic dermatitis (including on the scalp) should be treated with topical ketoconazole 2% two to three times per week for four weeks, with a maintenance treatment once per week as needed.

HIV-infected children and adults with severe seborrhoeic dermatitis and those patients with mild seborrhoeic dermatitis unresponsive to first-line therapy should be treated with a combination therapy of topical antifungals (e.g. ketoconazole 2%) and topical corticosteroids.

(seborrhoeic dermatitis) In HIV-infected children, adolescents, pregnant women and adults with papular pruritic eruption, ART should be considered as the primary treatment

(seborrhoeic dermatitis) Additional symptomatic therapy with antihistamines and topical corticosteroids (class 3, 4, 5 or 6, e.g. betamethasone valearate) is also recommended for the duration of persistent symptoms.

ART should be considered as the primary treatment of eosinophilic folliculitis in eligible patients

All HIV-infected adults (including pregnant women), adolescents and children who have been initiated on ART and who subsequently develop HIV-associated eosinophilic folliculitis should not discontinue the ART.

In children and adults (including pregnant women) with tinea infections that are not extensive, topical treatment with terbinafine 1% cream/gel (for two weeks) or miconazole (for three to four weeks) should be initiated.

In children and adults with extensive tinea infections or hair/nail involvement, oral griseofulvin should be considered

(In children and adults with extensive tinea infections or hair/nail involvement, oral griseofulvin should be considered) If there is no response, then oral terbinafine or itraconazole should be used.

In children and adults having tinea infections with unknown HIV status, an HIV test should be offered.

For all HIV-infected children, adolescents and adults (including pregnant women) with herpes zoster, acyclovir is recommended to prevent dissemination and for resolution of disease (at any time in the course of the disease).

All children, adolescents and adults presenting with herpes zoster with unknown HIV status should be offered an HIV test and, if positive, assessed for ART eligibility

For severe or crusted scabies in HIV-infected children <15 kg, • topical permethrin 5% (or alternatively benzyl benzoate) until clinically clear, as longer treatments may be required.

In addition, a keratolytic, such as 5% salicylic acid, can be used to remove scale bulk

ART should be considered as the primary treatment of extensive and/or unusually distributed molluscum contagiosum in HIV-infected patients. No additional specific treatment is recommended

All adults presenting with new-onset molluscum contagiosum in high HIV-prevalence settings with unknown HIV status should be offered an HIV test and, if positive, assessed for ART eligibility.

Oropharyngeal candidiasis. In adults: • Oral fluconazole 100–150 mg for seven to 14 days is recommended as the preferred treatment. • When fluconazole is not available or contraindicated, alternatives include topical therapy with nystatin suspension or pastilles, or clotrimazole troches.

ART eligibility: • Prompt ART initiation is recommended in all HIV-infected adults (including pregnant and breastfeeding women), adolescents and children with orophyaryngeal candidiasis.

In HIV-infected children and adults with Stevens-Johnson syndrome or toxic epidermal necrolysis, the suspected causative drug should be promptly discontinued and supportive therapies should be offered.

(In HIV-infected children and adults) Stevens- Johnson syndrome & toxic epidermal necrolysis: The use of systemic corticosteroids is not recommended.