Derm Cases · Dermatology / Infectious Diseases / HIV Medicine
OSCE — dermatology in HIV: indicator diseases, Kaposi sarcoma, IRIS, and drug reactions
An 8-minute OSCE station on recognising HIV-indicator skin disease (severe seborrhoeic dermatitis, KS, crusted scabies, oral hairy leukoplakia), initiating HIV testing pathways, Kaposi sarcoma principles, and ART-related IRIS and hypersensitivity reactions.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on recognising HIV-indicator skin disease (severe seborrhoeic dermatitis, KS, crusted scabies, oral hairy leukoplakia), initiating HIV testing pathways, Kaposi sarcoma principles, and ART-related IRIS and hypersensitivity reactions.
Brief (to candidate)
A 38-year-old has extensive purple oral and cutaneous plaques, thrush, and weight loss. Another patient develops fever and worsening skin lesions weeks after starting ART. You have 8 minutes to recognise HIV-related dermatoses, prioritise tests, and outline management principles including IRIS.
[5]Candidate instructions
- List HIV indicator skin/mucosal findings prompting testing.
- Recognise Kaposi sarcoma and first principles of management (ART ± oncology).
- Differentiate severe infection patterns (crusted scabies, bacillary angiomatosis, crypto).
- Explain IRIS after ART initiation.
- Mention key ART drug reactions (e.g. abacavir HSR with HLA-B*5701; nevirapine SJS risk context).
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Indicator conditions | Explosive/severe seborrhoeic dermatitis, recalcitrant psoriasis, oral candidiasis, oral hairy leukoplakia, pruritic papular eruption, extensive molluscum in adults, crusted scabies, unexplained zoster — offer HIV testing[1][2] |
| Kaposi sarcoma | HHV-8 driven vascular neoplasm: purple patches/plaques/nodules skin ± oral GI; staging/CD4 context; ART cornerstone ± local/systemic oncology therapy[3][4] |
| Opportunistic skin infections | Crusted scabies (high mite burden, isolate/treat carefully); bacillary angiomatosis vs KS; deep fungi (crypto, histo) in advanced immunosuppression[9][10][11] |
| IRIS | Paradoxical worsening of infection/inflammation after ART immune recovery — diagnose carefully, continue ART in most cases, treat pathogen, selective anti-inflammatory use under specialist care[5] |
| Drug reactions | Abacavir hypersensitivity — screen HLA-B*5701 before use; nevirapine and other agents linked to severe cutaneous adverse reactions including SJS/TEN — stop culprit, emergency care if epidermal necrosis[7][8] |
| Work-up | HIV Ag/Ab, CD4, VL (HIV service), biopsy of KS-suspected lesions, STI screen as indicated |
| Communication | Confidential testing consent, linkage to HIV care, non-stigmatising language |
Model key actions
- Offer HIV testing for indicator dermatoses and recognise Kaposi sarcoma with ART-centred care.[1][3]
- Explain IRIS as immune reconstitution phenomenon rather than automatic ART failure/stop.[5]
- Respect HLA-B*5701/severe CADR pathways for ART agents.[7][8]
Common errors
- Missing HIV testing in crusted scabies/OHL/severe seborrhoeic disease.
- Stopping ART automatically for every IRIS without specialist input.
- Confusing bacillary angiomatosis with KS without work-up.
- Prescribing abacavir without HLA-B*5701 process.
- Stigmatising communication that blocks testing.
References10ShowHide
- [1]Karadag AS, Elmas ÖF, Altunay İK, et al. Cutaneous manifestations associated with HIV infections: A great imitator. Clinics in Dermatology, 2020.PMID 32513397
- [2]Mohseni Afshar Z, Goodarzi A, Emadi SN, et al. A Comprehensive Review on HIV-Associated Dermatologic Manifestations: From Epidemiology to Clinical Management. International Journal of Microbiology, 2023.PMID 37496761
- [3]Cesarman E, Damania B, Krown SE, et al. Kaposi sarcoma. Nature Reviews Disease Primers, 2019.PMID 30705286
- [4]Patel R, Lurain K, Yarchoan R, et al. Clinical management of Kaposi sarcoma herpesvirus-associated diseases: an update on disease manifestations and treatment strategies. Expert Review of Anti-infective Therapy, 2023.PMID 37578202
- [5]Müller M, Wandel S, Colebunders R, et al. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. The Lancet Infectious Diseases, 2010.PMID 20334848
- [7]Waters LJ, Mandalia S, Gazzard B, et al. Prospective HLA-B*5701 screening and abacavir hypersensitivity: a single centre experience. AIDS, 2007.PMID 18025891
- [8]du Toit JD, Kotze K, van der Westhuizen HM, et al. Nevirapine-induced Stevens-Johnson syndrome in children living with HIV in South Africa. Southern African Journal of HIV Medicine, 2021.PMID 33824730
- [9]Akram SM, Anwar MY, Thandra KC, et al. Bacillary Angiomatosis. StatPearls, 2026.PMID 28846267
- [10]Noguchi H, Matsumoto T, Kimura U, et al. Cutaneous Cryptococcosis. Medical Mycology Journal, 2019.PMID 31787730
- [11]Niode NJ, Adji A, Gazpers S, et al. Crusted Scabies, a Neglected Tropical Disease: Case Series and Literature Review. Infectious Disease Reports, 2022.PMID 35735761