LIFE and GAFFI news release
WHO issues guidelines on skin and oral conditions in HIV adults and
children
In a quiet moment in late 2014, the
World Health Organisation issued
guidelines for the management of
several HIV-related skin and oral
diseases, in low resource settings. Lead
by Prof Rod Hay (International
Foundation for Dermatology, London)
and Toby Maurer (UCSF School of
Medicine, San Francisco), all the
clinical trial evidence for diagnosis and
management was scrutinized using the Grade criteria, and recommendations
made.
The conditions covered include the
fungal conditions oral candidiasis,
seborrhoeic, dermatitis, eosinophilic
folliculitis and tinea infections and the
non-fungal conditions Kaposi sarcoma,
popular pruritic eruption, herpes zoster,
scabies, mollucscum contagiosum,
Stevens-Jonson syndrome and toxic
epidermal necrolysis.
The treatment recommendations can be summarized:
 Oral candidiasis – adults: Fluconazole 100-150mg/d for 7 days, or topical
alternative
– children: Fluconazole 3mg/Kg for 7-14 days, or topical
therapy with clotimazole or nystatin
 Seborrhoeic, dermatitis – mild: topical ketoconazole 2% 2-3 times weekly
for 4 weeks, then weekly
– severe: topical antifungals (ie ketoconazole 2%)
and corticosteroid ointment
 Eosinophilic folliculitis: Oral antihistamine first. If no response add topical
corticosteroid (ie betamethasone). If no response add itraconazole
(200mg daily). If no response add permethrin 5% cream (above the
waist).
 Tinea infections – localized: topical terbinafine 1% cream/gel for 2 weeks
or miconazole topically for 4 weeks.
– extensive or hair/nail invovement: oral griseofulvin or
itraconazole 200mg daily, duration dependent on infection site.
Separate recommendations are made for pregnancy.
The guidelines are here: and available on line through the Maternal and Child
Health division of WHO here:
www.who.int/maternal_child_adolescent/documents/en/
Seborrheic dermatitis
3 more images to come.
Top photo on right is an abacavir rash in a 10 year old.
Second is severe oral candidiasis