Aids, dermatologists sentinel against HIV, warning signs on the skin

When the skin gets sick it can reveal a lot. In the case of HIV, in particular, skin signs are often the first to appear and represent the alarm bells for a diagnosis that, if timely, can make the difference. For this reason, dermatologists can be real sentinels for this infection. This is highlighted by the Italian Society of Dermatology and Sexually Transmitted Diseases (Sidemast), which underlines an increasingly strategic role of the dermatologist in the fight against HIV infection in view of the National Congress Sidemast - Special Edition 2025, organized as part of the XIV International Congress of Dermatology, in Rome from 18 to 21 June.

"90% of people with HIV develop at least one skin disease before diagnosis or during treatment - explains Maria Concetta Fargnoli, vice president of Sidemast and scientific director of the IRCCS Istituto dermatologico San Gallicano in Rome - This shows how important the prompt intervention of the dermatologist is, which can play a key role in the early diagnosis of the disease and in speeding up the patient's care". Some skin diseases, she adds, "although not specific to HIV, can represent an early sign of HIV infection, especially when they present themselves in an atypical, serious and above all treatment-resistant form".

"The manifestations that should alert the patient - he specifies - are a maculo-papular rash similar to that of mononucleosis or measles, seborrheic dermatitis, often more extensive and resistant to treatments than the common forms, recurrent or particularly extensive Herpes zoster, widespread scabies refractory to standard therapies, chronic fungal infections such as oral and esophageal candidiasis, extensive dermatophytosis, particularly severe forms of psoriasis".

'We need a task force on research, training and coordination with other specialists'

"The dermatologist is therefore, in many cases, the first specialist to intercept the infection - underlines Lidia Sacchelli, research fellow at the Policlinico Sant'Orsola Malpighi in Bologna - the presence of which must then be confirmed by a blood test with specific tests for HIV. In this sense we could talk about 'sentinel dermatologists', who as soon as they identify the criticality can then activate the entire diagnostic-therapeutic process". But despite the importance of the dermatologist in this sector, there are still significant obstacles in the early diagnosis of HIV from skin manifestations. First of all, the lack of updated operational guidelines that provide professionals with clear tools to identify suspected cases.

"We need tools and training to improve the ability to make early diagnoses - Fargnoli highlights - Only in this way will we be able to be even more timely, considering that the less time passes between the identification of a suspicious sign" and the diagnosis "the more possibilities we will have to limit the course of the disease and its consequences". To strengthen the dermatological presence in the management of HIV, Sidemast together with other dermatological societies has launched the proposal of a task force of expert dermatologists venereologists, recognized at a scientific level and able to guide research, training and coordination with infectious disease specialists and other specialists.

"As Sidemast - concludes Fargnoli - we are actively involved in research on sexually transmitted infections and we combine dermatological and infectious disease expertise. Our goal is to further specialize dermatologists to recognize increasingly timely the signs that may indicate the presence of HIV, and to collaborate in a structured manner with infectious disease colleagues for the best possible treatment". A particularly useful goal considering that the HIV numbers in Italy are not reassuring. According to updated data from the Istituto Superiore di Sanità, 2,349 new cases were reported in 2023, corresponding to an incidence of 4 new cases per 100,000 inhabitants. A value that marks a worrying increase compared to 2022 and that brings attention back to the levels prior to the Covid-19 pandemic: after a downward trend observed between 2012 and 2020, since 2021 a constant increase has been recorded again.