Do any photosensitive dermatoses occur in HIV disease?

Various photosensitive dermatoses have been described in HIV disease, and these include porphyria cutanea tarda (PCT), lichenoid photoeruptions, and chronic actinic dermatitis. Photosensitivity may, in fact, be the presenting sign of HIV infection.

Most cases of PCT in HIV infection are acquired and many are associated with historical or serologic evidence of hepatitis B or C infection, as well as with elevated transaminase levels and history of alcohol abuse. Patients present with blisters, erosions, crusting, scarring, and increased skin fragility on the face and dorsal hands. In one study, urinary and stool porphyrin excretion patterns classic for PCT occurred in hepatitis C–positive AIDS patients without any clinical evidence of porphyria.

Lichenoid photoeruptions in HIV infection occur most often in black individuals with advanced HIV disease and may be associated with photosensitizing drug use. Patients present with pruritic, violaceous plaques that begin on the face, neck, dorsal hands, and arms. The plaques may become hyperpigmented, hypopigmented, or depigmented and may extend to non–sun-exposed sites. Histopathologic features are primarily those of lichenoid drug eruption or hypertrophic lichen planus, but some patients have findings of lichen nitidus. Patients may improve or clear with discontinuation of a photosensitizing drug, sun avoidance, and sunscreen use.

Chronic actinic dermatitis has been described in markedly immunosuppressed patients and presents as a chronic pruritic and idiopathic eczematous dermatitis in a photodistribution. Phototesting shows increased sensitivity to ultraviolet B. Histologic findings demonstrate eczematous, lymphoma-like, and psoriasiform changes.

O’Connor WJ, Murphy GM, Darby C, et al: Porphyrin abnormalities in acquired immunodeficiency syndrome, Arch Dermatol 132:1443–1447, 1996.