Cutaneous manifestations of HIV infection (chronic varicella zoster infection) Figure 18-1 illustrates a form of infection with varicella zoster virus that is unique to patients with immune suppression from HIV. The 6-year-old child pictured here developed recurrent vesicular and ulcerative lesions of the trunk and extremities following an episode of chickenpox. The lesions contain numerous multinucleated giant cells and are culture-positive for varicella zoster virus.

Cutaneous manifestations of HIV infection (herpes zoster infection) In addition to chronic infections with varicella zoster, many patients develop unusual forms of herpes zoster infection. These patients also develop prolonged episodes of shingles that do not respond quickly to appropriate antiviral agents; they may also develop generalized varicella zoster infections.

Cutaneous manifestations of HIV infection (scarring from herpes zoster) Figure 18-3 shows a 3-year-old girl developed herpes zoster as an early manifestation of her immune deficiency. Despite therapy with intravenous acyclovir, severe scarring resulted. Herpes zoster generally occurs more frequently in children who have had chickenpox very early in life. Although herpes zoster is certainly seen in the healthy child, its occurrence in a child who is at risk for HIV infection should signal concern.

Cutaneous manifestations of HIV infection (candidal paronychias and nail dystrophy) Candidiasis is the most common mucocutaneous manifestation of pediatric HIV infection. Children with AIDS or lesser forms of HIV-related disease frequently develop oral thrush, which recurs or persists despite topical antifungal therapy. Recalcitrant infections of the diaper area and neck folds are also common. Illustrated in Fig. 18-4 are chronic paronychias with a resultant nail dystrophy.