In their editorial, Costner and Cockerell1 mention several skin conditions related to human immunodeficiency virus (HIV) that improve during highly active antiretroviral treatment (HAART). They do not mention, however, the potential adverse dermatological effects of such therapy.
The protease inhibitor indinavir sulfate, for example, may cause alopecia, dry skin, pruritic skin eruptions, and paronychia.2,3 We observed 2 patients treated with indinavir who developed a vertical lip fissure during the summer. The fissure of the lips probably was related to the dryness of the lips caused by the indinavir. We also observed a patient who lost all the hair on his legs and axillary region during indinavir, stavudine, and lamivudine treatment. His hair started growing again when the indinavir was replaced by nelfinavir. Allergic skin eruptions can be seen with all antivirals but may be particularly severe, leading to a Stevens-Johnson syndrome, with abacavir.4
Colebunders R, Vandenbruaene M. The Changing Spectrum of the Cutaneous Manifestation of HIV Disease. Arch Dermatol. 1999;135(4):471. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-4-dlt0499