Histopathologic features seen in cutaneous photoeruptions in HIV-positive patients. Military Medical Consortium for the Advancement of Retroviral Research (MMCARR).
BACKGROUND
There have been scattered reports of HIV+ patients with increased reactions to light as well as anecdotal reports of HIV+ patients with increased morbidity secondary to radiation therapy.


METHODS
As a part of a military study of HIV+ patients, we followed 987 patients for cutaneous disease for 4 years. All patients were questioned on a periodic basis about increased sensitivity to light. These patients received a physical examination at each protocol visit, and they were given the opportunity to receive all their dermatologic care within the HIV clinic. Fourteen of the patients with photo-induced eruptions were evaluated clinically at the time of the eruption, and 11 of these were biopsied.


RESULTS
Thirty-three of the patients reported photo-induced reactions unrelated to oral medications. Although sensitivity to light often began in the early stages of HIV disease, reactions became more severe and more chronic with disease progression. Histologic features varied from few to numerous apoptotic/necrotic keratinocytes within the mid to upper levels of the epidermis associated with a perivascular inflammatory infiltrate, to apoptotic/necrotic keratinocytes throughout an acanthotic epidermis with a lichenoid/interface infiltrate.


CONCLUSIONS
Although the pathogenesis of these light reactions is not known, these reactions may be related to depletion of endogenous scavengers which results in increased oxidative stress and is modulated by the pattern of immune dysregulation and metabolic dysregulation induced by HIV disease.
Smith
K J
KJ
National Naval Medical Center, Bethesda, Maryland, USA.
Skelton
H G
HG
Yeager
J
J
Tuur
S
S
Angritt
P
P
Wagner
K F
KF
D000051:Acantholysis / Q000473:pathology; D000328:Adult; D017209:Apoptosis; D001706:Biopsy; D002908:Chronic Disease; D003713:Dendritic Cells / Q000276:immunology / Q000473:pathology; D003872:Dermatitis / Q000473:pathology; D018450:Disease Progression; D004817:Epidermis / Q000473:pathology; D005089:Exocytosis; D005260:Female; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000378:metabolism; D006679:HIV Seropositivity / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D015603:Keratinocytes / Q000473:pathology; D017512:Lichenoid Eruptions / Q000473:pathology; D008027:Light / Q000009:adverse effects; D008214:Lymphocytes / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D018384:Oxidative Stress; D010787:Photosensitivity Disorders / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D010808:Physical Examination
D016166:Free Radical Scavengers