PHOTOSENSITIVITY AS THE PRESENTING ILLNESS IN 4 PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRAL-INFECTION

Background: A multitude of skin lesions have been reported in individu als with human immunodeficiency virus (HIV) infection. Some of them, e g, severe seborrheic dermatitis and herpes tester infections, may pred ate the onset of the diagnostic criteria for the acquired immunodefici ency syndrome and may actually raise the suspicion of HIV infection in healthy-appearing individuals. We have recently evaluated four indivi duals who presented with a severe idiopathic photosensitivity of eczem atous morphologic features who eventuated in a diagnosis of HIV seropo sitivity. Four individuals who presented with an eczematous eruption o f sun-exposed skin were referred to the Environmental Dermatology Unit of Columbia-Presbyterian Medical Center (New York, NY) for evaluation of possible photosensitive disease. They were examined and underwent photobiological testing (minimal erythema dose testing and photopatch testing) to confirm and classify their suspected photosensitivity. Obs ervations: All four patients fulfilled the criteria for chronic actini c dermatitis, a rare idiopathic photosensitivity characterized by debi litating, unremitting dermatitis with eczematous or lymphomalike histo logic features and reproduction of lesions by small quantities of mid- wave UV-B radiation (290 to 320 nm). All four individuals were HIV ser opositive and CD4 counts were markedly suppressed in all four. The pho tosensitivity predated the finding of seropositivity and the diagnosis of acquired immunodeficiency syndrome in all four patients. Conclusio n: The presentation of healthy-appearing individuals with photodistrib uted dermatitis of unknown cause should alert the physician to the pos sibility of HIV infection.