Features of the clinic and treatment of skin lesions in HIV infection

Pathological changes in the oral cavity, as well as diseases of the oral mucosa are one of the symptoms of the presence of the immunodeficiency virus in the body. However, one should not think that the presence of dental problems may indicate infection with the immunodeficiency virus. To understand how oral diseases are related to HIV infection, it is worth talking in more detail about the immunodeficiency virus and its vital functions.

What is HIV? What is HIV infection

The human immunodeficiency virus, or HIV, was identified and described relatively recently. Invading the human body, it primarily affects macrophage cells and T-lymphocytes, which are responsible for recognizing and destroying hostile bacteria. Thus, the body's immune barrier loses its ability to resist both external bacterial attacks and internal opportunistic flora.

The immunodeficiency virus is transmitted exclusively through sexual contact or through direct contact of a healthy body with infected blood. Transmission of the virus through household or food contact is impossible.

HIV infection is a slow-onset disease caused by a virus and occurs against a background of suppressed immunity. It can take years from the introduction of the virus to the clinical manifestations of the disease. During this entire period, the virus does not manifest itself in any way, and its presence can only be diagnosed using a laboratory method.

Why does psoriasis start on the hands?

Psoriasis on the hands in the form of single regular plaques is only a seemingly local pathological process. In fact, even 1-2 elements of the rash indicate the presence of a chronic inflammatory skin disease. Medicine has not yet been able to unravel all the mysteries of this disease. The exact causes of psoriasis have not been identified. It is only known that the pathological process is based on burdened heredity and immune disorders.

Currently, the genes responsible for the hereditary transmission of predisposition to psoriasis, including on the hands, are being identified and studied. Under the influence of genes, a change in metabolism occurs and a decrease in the content of enzymes that destroy substances involved in inflammatory reactions.

Immunity is also impaired, which leads to a multiple acceleration of cell division in the surface layers of the skin. The cells do not have time to mature when new underlying cells push them to the surface. This is another cause of psoriasis on the hands.

Psoriasis of any localization can spread throughout the body, so do not delay treatment.
See how easily the disease can be cured in 10-12 sessions.

Such changes lead to the appearance of characteristic symptoms of the disease. What does psoriasis look like on the hands? Initially, a scaly spot appears on the hands, sometimes on other parts of the body, which quickly turns into a papule with a raised inflammatory base. The papules grow and merge, forming huge plaques.

But not all genetically predisposed people develop the disease. The reason is the lack of exposure (or minor exposure) to provoking factors. If you avoid these factors, you may never get sick, even if both parents have psoriasis.

HIV infection of the oral cavity and its causes

Inflammatory processes in the mucous tissues of the oral cavity are one of the first symptoms of virus activation. This is due to the peculiarity of the structure of the oral cavity and its constant contact with the aggressive external environment. Most often, the mucous membrane is affected by the herpes simplex virus, Candida fungus, Epstein-Barr virus, and papillomaviruses. Bacterial infections are caused by streptococci and staphylococci, which are no longer contained by local immunity. In conditions of immunity suppressed by the virus, periods of remission become shorter, and inflammatory processes are acutely progressive. Timely prescribed additional studies make it possible to correctly prescribe a course of maintenance therapy, since diseases of the oral mucosa are not directly a symptom of HIV infection.

Based on their suspected association with HIV, oral infections are divided into three groups.

Group 1 includes pathologies most closely associated with the immunodeficiency virus:

• candidiasis, colloquially “thrush”;
• hairy leukoplakia (changes in the mucous membrane of the tongue);
• HIV gingivitis (acute inflammation of the gums);
• HIV periodontitis (periodontal inflammation);
• Kaposi's sarcoma (a specific neoplasm on the hard palate of the oral cavity);
• non-Hodgkin's lymphoma.

The 2nd group of diseases includes lesions to a lesser extent, associated with symptoms of HIV infection:

• thrombocytopenic purpura (multiple hemorrhages);
• pathology of the salivary glands;
• viral infections (herpes).

Group 3 includes diseases that often occur with HIV infection, but are not associated with it. Below we will consider diseases from the first group, as the most characteristic of the state of immunodeficiency.

Is it true that a condom does not protect completely?

So far, the only thing more reliable than a condom in preventing STIs is the absence of any sexual contact. WHO calls

male condoms are approximately 80–85% effective. Gaps in effectiveness are mainly due to improper storage and use of products No. 2.

– It is worth understanding that 80% is average data from the entire planet. The statistics are mainly worsened by third world countries, where used condoms are washed, dried and reused, says Nikolai Lunchenkov.

From time to time you can hear that latex and other materials allow viruses to pass through, but an infectious disease specialist calls this a myth and urges not to believe in it. The Fact Sheet for Public Health Personnel from the US Centers for Disease Control and Prevention (CDC) states that latex condoms provide an impenetrable barrier to particles the size of STIs.

After all, most condoms are coated with a lubricant that can fill hypothetical micropores.

Previously, Roskachestvo examined the quality of condoms. See the results HERE

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Symptoms of HIV infection in the oral cavity

The herpes simplex virus is present in most people. The infection persists in the body throughout life and does not cause any special problems, except for rare rashes on the lips.

Herpetic gingivostomatitis

In HIV-infected people, herpes rashes are chronic with rare stages of remission. It is distinguished by blistering rashes around the mouth and on mucous tissues. When the vesicles open, painful erosions occur that develop into fairly large ulcers. The manifestation of herpes zoster and rashes in atypical places is also noticed.

Candidiasis

Candidiasis is also a common symptom of HIV infection and is chronic. Its symptoms are the same as with regular thrush, the only difference being that plaque covers most of the mouth.

Hairy leukoplakia

Clinical manifestations of the disease look like deformed mucous tissue, externally resembling folds or hairs. Localization area: lateral parts of the tongue and the inner surface of the cheeks. Painful sensations are usually absent.

HIV gingivitis and periodontitis

In this case, the infection manifests itself as acute inflammation of the gums. Starting with ordinary bleeding gums, the disease quickly develops into an acute form. With adequate treatment, tooth loss can be avoided.

Kaposi's sarcoma

This is one of the most characteristic symptoms of HIV infection in the clinical stage of manifestation. The tumor is formed from lymphatic vessels, in the mouth it is located near the root of the tongue, less often on the gums.

How to properly store and use condoms?

There are many nuances that the UK National Health Service (NHS) writes about.

Condoms should be stored in a place that is not too warm and not too cold. That is, keeping them in a car that sits in the cold at night is just as undesirable as carrying them in a trouser pocket. The optimal temperature is room temperature. Of course, products should be kept away from sharp objects that could puncture the packaging. Leaving the bag dangling loosely in a backpack or bag is a bad idea, because it can be damaged unnoticed by a collision with a bunch of keys and other things.

Before use, it is important to carefully open the package without using your teeth. When putting on a condom, press down on the accumulator to squeeze out the air from it. Gently roll the product to the base of the penis.

You should not use the same condom more than once - no matter how obvious it may sound. It was mentioned above that in some countries, repeated use is considered normal, which makes the spread of HIV in such areas particularly difficult to contain.

There is no need to put one on top of the other: contrary to expectations, the protection will be less reliable - condoms are more likely to break.

Oil-based lubricants should not be used with latex and polyisoprene condoms, as the products may break. The same can be said about any oil and Vaseline. If a woman uses vaginal suppositories (for example, for treatment), this also increases the risk of rupture. In this case, it is better to use polyurethane condoms, they are invulnerable to fat.

Diagnosis for suspected HIV infection

For differentiated diagnosis of HIV infection from similar dental diseases, the following tests are used:

1. Blood test for PCR reaction (aimed at detecting HIV).
2. Immunoblotting technique.
3. Linked immunosorbent assay.
4. Checking immune status.

If the results are unclear, additional blood tests, as well as bacteriological studies, may be prescribed. Early diagnosis of the root cause of diseases can significantly alleviate the course of the disease.

Symptoms of psoriasis on the hands

The disease can begin and progress differently depending on the form. Symptoms of psoriasis on the hands can also vary.

Vulgar form

This is the most common form. On the hands, the skin of the extensor area of ​​the joints, as well as the forearms, wrists, dorsum of the hands, and fingers are usually affected. In the area of ​​the elbows, so-called standby plaques appear on both sides, which can remain in the same state for years without progressing. On the back of the hands, the disease progresses more often, since the skin in these areas is constantly exposed to various influences. Psoriasis often appears on the fingers. In case of damage to the little fingers and thumbs, the risk of injury to psoriatic elements increases.

The first signs of psoriasis on the hands are the appearance of one or more scaly spots, which quickly turn into papules with a raised inflammatory base. If you scratch the top of such a papule, a number of characteristic symptoms appear:

• type of stearin drop - multiple white flakes;
• if you scrape off all the scales, a transparent film will be visible;
• Slightly scraping the film leads to the appearance of droplets of blood on it.

These symptoms are the hallmark of a psoriatic rash. In the future, the primary symptoms of the disease may progress, with the papules increasing in size, merging with each other and forming large plaques, and new elements appear. Possible damage to nails. Over time, the progression stops, after which the recovery process begins: the rash slowly turns pale and disappears.

Exudative form

This form of the disease is less common. The skin on the back of the hands is usually affected. Often this type of psoriasis also affects the fingers. Characterized by the appearance of swelling, exudate on the surface of the rash elements, severe itching and a constant feeling of discomfort. As a result, the scales stick together to form grayish-yellowish crusts on the surface of the papules on the skin of the hands and fingers. In this case, peeling is not very noticeable, but the risk of bacterial infection increases. What exudative psoriasis looks like on the hands can be seen in the photo:

Palm shape

Psoriasis on the palms can occur in the form of plaque-fan-shaped, horny and pustular forms.

The plaque-fan-shaped form is characterized by the formation at the initial stage of rash elements in the form of scaly papules, merging into large plaques. The rashes are localized mainly on the palms and fingers. It often recurs and is difficult to treat. The reason for this is the constant exposure to various external factors. The skin between the fingers is affected. They turn red, swell, and become covered with cracks and scales. Often such rashes spread to the fingertips and nail plates.

The horny form is manifested by dry skin, thickening on the palms, the appearance of cracks and dry calluses.

Psoriasis on the palms of the hands may look like pustules. This is the so-called Barber pustular psoriasis. Purulent blisters appear on the surface of the palms, which can merge with each other, forming purulent lakes. The contents of the pustules are sterile. Photo:

Treatment methods for psoriasis on the hands

How to treat psoriasis on the hands? This problem arises immediately after diagnosis. Experts recommend comprehensive treatment, which includes:

• changing lifestyle, daily routine;
• getting rid of bad habits;
• proper nutrition;

Lifestyle recommendations

Patients with psoriasis localized on the hands need to:

• regulate wakefulness and sleep patterns;
• engage in feasible sports; Activities such as outdoor running, swimming, tennis are welcome; avoid contact sports (wrestling);
• important: after playing sports, be sure to take a shower - sweat irritates the skin and can provoke an exacerbation of the pathological process;
• wash only with soft washcloths using hypoallergenic detergents;
• After a shower, apply moisturizer to your body;
• use underwear made from cotton fabrics;
• in the cold season, wear gloves (mittens) with flannel lining;
• Avoid contact with household chemicals and any other chemicals.

Drug therapy

Good to know

• Treatment of psoriasis on the head
• Treatment of psoriasis on the elbows
• Treatment of psoriasis on the legs
• Treatment of psoriasis on nails
• Treatment of psoriasis on the face
• Treatment of palmoplantar psoriasis

In mild cases, psoriasis on the hands is treated locally, using various external agents and procedures. Prescribed:

• keratolytics - medicinal ointments and creams that dissolve surface layers of dead epithelial cells (salicylic acid);
• emollients (tar-based psoriasis ointment);
• synthetic analogues of vitamin D (calcipotriol);
• synthetic analogues of vitamin A (retinoids);
• glucocorticosteroid (GCS) hormones - allow you to treat all forms of hand psoriasis;
• combination products that include GCS + salicylic acid (Diprosalik) or GCS and calcipotriol (Daivobet);
• creams and ointments with active zinc;
• medicinal baths with herbs (celandine, chamomile, calendula).

If the symptoms of psoriasis on the hands do not go away, the disease progresses, and general therapy must be prescribed. It should be carried out in a hospital setting:

• droppers with medicinal solutions that eliminate intoxication;
• injections of drugs that remove toxins (Unitiol, magnesium sulfate);
• desensitizing (eliminating allergies) and sedatives; 1st generation antihistamines (Suprastin, Tavegil) are most suitable;
• glucocorticoids - taken orally or by injection - have a pronounced anti-inflammatory and desensitizing effect, relieve itching;
• cytostatics - drugs that suppress too frequent division of epithelial cells;
• Immunosuppressants are medications that suppress the excessive sensitivity of the immune system.

Diagnosis of human immunodeficiency virus

It is important for any person to know what HIV tests are available in clinics. To detect infection, an enzyme-linked immunosorbent assay is performed to detect antibodies to HIV in biological fluids. A positive result can only be after the end of the incubation period, when the body has already synthesized antibodies to the virus. The test is done no earlier than 4 weeks after contact, the results will be reliable after 3-4 months, control tests are taken after 6 and 12 months.

If the ELISA is positive, the blood sample is retested by immunoblotting. If this test gives a positive answer, the probability of HIV reaches 99.9%. If the immunoblot test is negative, there is no virus in the blood. An indeterminate test result is possible during the incubation period, when there are still few viral particles, or after treatment of the infection.

If HIV is detected, the patient is given tests to measure the amount of viruses in the blood plasma (the so-called viral load) and the patient's immune status is determined.

How to eat healthy

Nutrition is of particular importance as it affects metabolism, the disturbances of which underlie the disease. It is useless to treat psoriasis without following a diet. Important: in the patient’s diet, 70% should be products of plant origin and only 30% should be animal products. Recommended to use:

• any fruits and vegetables (fresh, boiled, stewed) except those prohibited;
• fresh juices; Citrus juices are especially useful; lemon juice can be used as a salad dressing;
• more clean water.

Limit consumption (no more than a few times a week):

• lean meat and fish;
• low-fat cottage cheese and fermented milk products;
• cereals;
• some fruits and berries: plums, currants, cranberries, blueberries.

Exclude from the diet:

• fat meat;
• fatty dairy products;
• sweets, baked goods;
• vegetables from the nightshade family: tomatoes, eggplants, hot and bell peppers;
• all spicy, sour, smoked, fried, canned foods;
• drinks: sweet soda, cocoa, strong coffee, tea, alcohol.

Classification of the disease by stages

During the course of the disease, it is customary to distinguish five successive stages. Each of them has its own specific characteristics. Source: Structural biology of HIV. B. G. Turner, M. F. Summers. Howard Hughes Medical Institute and Department of Chemistry and Biochemistry University of Maryland Baltimore County. https://www.sciencedirect.com/science/article /abs/pii/S0022283698923543?via%3Dihub.

The incubation stage lasts from the period when the virus enters the body until a reaction to it appears (in the form of the symptoms described above) or the production of antibodies. The duration of this stage is from 3-4 weeks to 3 months, in rare cases longer. During this period, viral particles actively spread throughout the body and multiply, but there are no clinical manifestations, HIV is not detected by laboratory tests, but the person is contagious.

The stage of primary manifestations begins approximately 3-6 months from the moment of infection. The virus continues to actively multiply during this period, and the immune system actively reacts to its presence by producing antibodies and clinical symptoms. During this period, the infection can be detected by laboratory examination: a specific test for HIV is performed. During this period, there may be no complaints, or periods of low-grade fever, skin rashes, lymph node reactions, candidiasis, relapses of herpes infection, and pneumonia may occur. The duration of acute HIV infection is 12 months from the moment antibodies appear.

The subclinical stage of infection is characterized by a slowdown in the process of virus reproduction and active synthesis of antibodies to existing particles. Among the leading symptoms are enlarged lymph nodes. The duration of the stage is about 5-7 years, sometimes it can extend to 10-20 years.

The stage of secondary diseases is characterized by the constant multiplication of viral particles, the death of the population of CD4 lymphocytes with the gradual depletion of the immune system resource. This leads to the formation of opportunistic infections (candidiasis, tuberculosis, herpes zoster) and oncological processes (Kaposi's sarcoma). The duration of the stage depends on the activity of treatment of secondary pathologies and the characteristics of the immune system.

The AIDS stage completes the development of the infection. Typically, the development of lesions of the nervous system, secondary severe infections and tumors, which pose a threat to life and occur as generalized processes. Without treatment, AIDS occurs approximately 10-12 years after infection.