CAUSES OF PRURITUS IN HIV PATIENTS IN HONG KONG

K K Lo, JWK Fung, Department of Health, Hong Kong

Objective:
To analyze the causes of pruritus in Human Immunodeficiency Virus (HIV) positive patients in Hong Kong.

Method:
This was a retrospective analysis of the dermatological diagnosis of all HIV positive patients referred to Dermatology clinics from March 1994 to August 1996. Patients with pruritus were selected out for further analysis and the underlying causes were tabulated.

Results:
A total of 122 patients were referred to Dermatology clinics for skin consultations. 79 of them complained of pruritic skin rashes which represented 64.8 percent of the total patients. The rest of the patients were diagnosed with either non-itchy dermatological diseases or non -dermatological diseases.

Out of these 79 patients, 10 patients (12.7%) were observed to have two skin disorders. Totally 16 dermatological disease entities were categorized. The commonest skin disease was eczema and there were 30 cases (37.9% of all patients with itchy skin diseases). Under this title, eczema was subdivided into the endogenous and the exogenous types. There were 29 patients (36.7%) in the endogenous group. These included 8 patients (10.1%) having popular eczema; 2 patients (2 5%) with asteatotic eczema; another 2 patients with discoid eczema and 1 patient (1.3%) with lichen simplex chronicus. 7 patients (8 9%) were found to have seborrheic eczema. The remaining 9 patients (11.3%) were classified into the non-specific eczematous skin disease. Only 1 patient (1.3%) got the exogenous type. The second commonest skin disease was hypersensitivity drug rashes and 17 patients (21.5%) suffered from it. 13 patients (16.4%) suffered from eosinophilic folliculitis and was the third commonest skin disease. 4 patients (5.1%) had psoriasis. 3 patients (3.8%) had pityrosporum folliculitis and another 3 patients had scabies. Other less common pruritic skin lesions include HIV papular dermatitis (2.5%), herpes roster (2.5%), perforating folliculitis (2.5%), fungal infections (2.5%), reactive erythema (1.3%), sebopsoriasis (1.3%), epidermodysplasia verruciformis (1.3%), keloid (1.3%), acne vulgaris (1.3%) and rosacea (1.3%).

Skin biopsies were performed in 13 pruritic patients (16 4%). 9 skin biopsies showed that the pathological diagnoses were compatible with the clinical diagnoses; 1 was not compatible and 3 showed non-specific findings.

Conclusion:
Pruritus was the commonest complaint leading to dermatology consultation in HIV positive patients which comprised 64.8 percent of total referred patients. Nearly 40 percent of the patients in the pruritic group suffered from eczema and it was the commonest skin disease. Drug rashes (21 5%) was the second commonest skin disease then came the eosinophilic folliculitis (16.4%).

One interesting point is that skin conditions that are non-itchy or mildly itchy in non-HIV patients such as folliculitis (both pityrosporum and eosinophilic types), psoriasis, acne vulgaris and rosacea may induce pruritus which is the major concern in HIV positive patients.