Letters to the Editor
rash-like rosacea and Demodex mites. A 50-year-old Japanese man suffered from scaly erythema on the trunk for 2 years and was diagnosed with psoriasis vulgaris by his primary care physician. He was treated with a topical corticosteroid, and was hospitalized for severe herpes zoster of the first division of the trigeminal nerve 6 months prior. After that, he suffered from butterfly rash-like skin eruption for 3 months. He was suspected of having systemic lupus erythematosus and was referred to our hospital (Fig. 1a). A skin biopsy of a facial lesion showed a variety of cellular infiltrates with follicular and perifollicular patterns, such as lymphocytes, neutrophils and plasma cells in the dermis. Many Demodex mites were observed within the hair follicle (Fig. 1b–d). In addition, immunofluorescent analysis of his skin revealed a significant reduction in CD4positive cells (Fig. 1e). In contrast, the number of CD8-positive cells was elevated (Fig. 1f). A precise history of the patient revealed that he had had multiple sex partners. Serological testing confirmed that he was infected with HIV. His CD4-positive cell count had decreased to 62 cells/mm3, and his HIV viral load was 2400 copies/mL. Crotamiton cream was applied to his face twice daily combined with systemic minocycline (100 mg/day), and steroid ointment was applied to his trunk for 2 months. Improvements in his skin symptoms were observed. The patient was transferred to a HIV flagship hospital. The presence of skin symptoms sometimes helps to diagnose HIV infection. More than 90% of HIV-infected patients have been reported to develop skin or mucous membrane lesions. In many cases of HIV, the skin is the first organ to be affected.1 Approximately 10% of patients with AIDS (CD4 count
rash-like rosacea and Demodex mites. A 50-year-old Japanese man suffered from scaly erythema on the trunk for 2 years and was diagnosed with psoriasis vulgaris by his primary care physician. He was treated with a topical corticosteroid, and was hospitalized for severe herpes zoster of the first division of the trigeminal nerve 6 months prior. After that, he suffered from butterfly rash-like skin eruption for 3 months. He was suspected of having systemic lupus erythematosus and was referred to our hospital (Fig. 1a). A skin biopsy of a facial lesion showed a variety of cellular infiltrates with follicular and perifollicular patterns, such as lymphocytes, neutrophils and plasma cells in the dermis. Many Demodex mites were observed within the hair follicle (Fig. 1b–d). In addition, immunofluorescent analysis of his skin revealed a significant reduction in CD4positive cells (Fig. 1e). In contrast, the number of CD8-positive cells was elevated (Fig. 1f). A precise history of the patient revealed that he had had multiple sex partners. Serological testing confirmed that he was infected with HIV. His CD4-positive cell count had decreased to 62 cells/mm3, and his HIV viral load was 2400 copies/mL. Crotamiton cream was applied to his face twice daily combined with systemic minocycline (100 mg/day), and steroid ointment was applied to his trunk for 2 months. Improvements in his skin symptoms were observed. The patient was transferred to a HIV flagship hospital. The presence of skin symptoms sometimes helps to diagnose HIV infection. More than 90% of HIV-infected patients have been reported to develop skin or mucous membrane lesions. In many cases of HIV, the skin is the first organ to be affected.1 Approximately 10% of patients with AIDS (CD4 count
