Guideline

Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults

Year of Publication

2014

Issuing Institution

WHO

Links

Google Scholar,WHO IRIS

Recommendations

27 included recommendations

In HIV-infected adults, adolescents and children diagnosed with mild/moderate Kaposi sarcoma, immediate ART initiation is recommended.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In HIV-infected adults, adolescents and children diagnosed with severe symptomatic Kaposi sarcoma, immediate ART initiation in combination with systemic chemotherapy is recommended.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Recommended chemotherapy regimens in adults, adolescents and children may include vincristine with bleomycin and doxorubicin (ABV), bleomycin with vincristine (BV), and when available or feasible, liposomal anthracyclines (doxorubicin or daunorubicin), paclitaxel or oral etoposide at sites with the infrastructure, staff and resources to administer chemotherapy drugs and provide appropriate monitoring and supportive care.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

HIV-infected children and adults with mild seborrhoeic dermatitis (including on the scalp) should be treated with topical ketoconazole 2% two to three times per week for four weeks, with a maintenance treatment once per week as needed.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

HIV-infected children and adults with severe seborrhoeic dermatitis and those patients with mild seborrhoeic dermatitis unresponsive to first-line therapy should be treated with a combination therapy of topical antifungals (e.g. ketoconazole 2%) and topical corticosteroids.

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low

In HIV-infected children, adolescents, pregnant women and adults with papular pruritic eruption, ART should be considered as the primary treatment

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

(papular pruritic eruption) Additional symptomatic therapy with antihistamines and topical corticosteroids (class 3, 4, 5 or 6, e.g. betamethasone valearate) is also recommended for the duration of persistent symptoms.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

ART should be considered as the primary treatment of eosinophilic folliculitis in eligible patients

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

All HIV-infected adults (including pregnant women), adolescents and children who have been initiated on ART and who subsequently develop HIV-associated eosinophilic folliculitis should not discontinue the ART.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

(eosinophilic folliculitis ) Additional symptomatic therapy is recommended for the duration of the persistent symptoms with, depending on severity: • oral antihistamine; if no adequate response, add • topical corticosteroids (class 3, 4, 5 or 6, e.g. betamethasone valearate); if no adequate response, add • oral itraconazole; if no adequate response, add • permethrin 5% cream (applied above the waist)

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

In children and adults (including pregnant women) with tinea infections that are not extensive, topical treatment with terbinafine 1% cream/gel (for two weeks) or miconazole (for three to four weeks) should be initiated.

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

In children and adults with extensive tinea infections or hair/nail involvement, oral griseofulvin should be considered

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

(In children and adults with extensive tinea infections or hair/nail involvement, oral griseofulvin should be considered) If there is no response, then oral terbinafine or itraconazole should be used.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

In children and adults having tinea infections with unknown HIV status, an HIV test should be offered.

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

For all HIV-infected children, adolescents and adults (including pregnant women) with herpes zoster, acyclovir is recommended to prevent dissemination and for resolution of disease (at any time in the course of the disease).

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

All children, adolescents and adults presenting with herpes zoster with unknown HIV status should be offered an HIV test and, if positive, assessed for ART eligibility

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

Mild/moderate scabies: • For scabies in HIV-infected children and adults (including pregnant women) topical application of permethrin 5% (two applications) is recommended. If permethrin is not available, benzyl benzoate (at least two applications) should be used. • If there is poor response to treatment, or permethrin treatment is not feasible, then oral ivermectin at 200 µg/kg is recommended.

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

For severe or crusted scabies in HIV-infected children ≥15 kg and adults: • two doses (with one to two weeks in-between) of oral ivermectin; • if ivermectin is not available, then treat with topical permethrin 5% (or alternatively benzyl benzoate) until clinically clear, as longer treatments may be required.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

For severe or crusted scabies in HIV-infected children <15 kg, • topical permethrin 5% (or alternatively benzyl benzoate) until clinically clear, as longer treatments may be required.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

(For severe or crusted scabies in HIV-infected children <15 kg) In addition, a keratolytic, such as 5% salicylic acid, can be used to remove scale bulk

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

ART should be considered as the primary treatment of extensive and/or unusually distributed molluscum contagiosum in HIV-infected patients. No additional specific treatment is recommended

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

All adults presenting with new-onset molluscum contagiosum in high HIV-prevalence settings with unknown HIV status should be offered an HIV test and, if positive, assessed for ART eligibility.

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

Oropharyngeal candidiasis. In adults: • Oral fluconazole 100–150 mg for seven to 14 days is recommended as the preferred treatment. • When fluconazole is not available or contraindicated, alternatives include topical therapy with nystatin suspension or pastilles, or clotrimazole troches.

Status

New

Recommended in favor

Strong

Certainty of evidence

Moderate

Oropharyngeal candidiasis. In children: • Oral fluconazole 3 mg/kg for children for seven to 14 days is recommended as the preferred treatment. • When fluconazole is not available or contraindicated, alternatives include topical therapy with nystatin suspension or pastilles, or clotrimazole troches. • In children with mild oropharyngeal candidiasis, topical therapy with nystatin suspension or pastilles (alternatively clotrimazole troches) is recommended.

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

ART eligibility: • Prompt ART initiation is recommended in all HIV-infected adults (including pregnant and breastfeeding women), adolescents and children with orophyaryngeal candidiasis.

Status

New

Recommended in favor

Strong

Certainty of evidence

High

In HIV-infected children and adults with Stevens-Johnson syndrome or toxic epidermal necrolysis, the suspected causative drug should be promptly discontinued and supportive therapies should be offered.

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low

(In HIV-infected children and adults) Stevens- Johnson syndrome & toxic epidermal necrolysis: The use of systemic corticosteroids is not recommended.

Status

New

Recommended against

Conditional

Certainty of evidence

Very low