One of the earliest harbingers of HIV infection is your skin. When certain infections or conditions develop, it can often be a sign that the HIV is progressing. That’s why we call the ones that take advantage of the infected person’s weakened immune system “opportunistic infections.” Meanwhile, other skin conditions are linked to the immune system rebounding due to the success of HIV treatments. Essentially, the status of your HIV infection can determine the presence and severity of many skin conditions. Generalized Skin Rashes If you’re feeling a little itchy, you might be able to chalk up the red, itchy or flaky skin to one of these causes of dermatitis: Atopic dermatitis. This chronic dermatological condition tends to make you itch, itch, itch. Xerosis. If you’ve got extremely dry or scaly patches on your arms and legs, it could be the result of xerosis. It can also affect your mucous membranes. Folliculitis. Also called eosinophilic folliculitis, this condition is characterized by red, itchy bumps. It’s caused by the body’s reaction to ordinary microorganisms that usually peacefully cohabit the hair follicles. Prurigo nodularis. Lots of itchy hard nodules or crusty lesions are the hallmark of this condition. Viral infections Viral infections that affect the skin are also very common in people with HIV. These viruses are common culprits: Herpes simplex virus. This virus causes annoying blisters and sores in people without HIV, but those blisters can develop into much more serious lesions in people who do have HIV. Varicella-zoster virus. Also called herpes zoster virus, this virus can cause the painful rash known as shingles. Blisters tend to form along one side of the body and can last for many weeks. It tends to be more severe in people who are immunocompromised, and in some cases, they may need an intensive form of antiviral chemotherapy to treat it. HPV. The human papillomavirus, or HPV, causes condyloma acuminatum, a condition better known as genital warts. Epstein-Barr virus. Oral hairy leukoplakia may sound like a disease from a science fiction show, but this condition is a real one caused by the Epstein-Barr virus. It tends to show up as white lesions on and around the tongue. Fungal infections Fungal infections tend to get worse when a person’s HIV progresses, as the immune system is weaker. A couple of the most common ones include: Thrush. Thrush, or oral candidiasis, is a very common annoyance among people with HIV. It’s essentially a yeast infection that causes a thick gooey layer of white lesions inside your mouth. In bad cases, it can even spread back to your throat and esophagus. Since it tends to be worse in people with suppressed immune systems, an effective HIV treatment is often the best way to keep thrush at bay. Seborrheic dermatitis. Think dandruff but worse. Experts think that a yeast is also responsible for this condition, which leads to a chronic inflammatory condition that tends to cause red, flaking or scaly patches on the skin. It’s most common on the scalp and face, but it can descend all the way down the torso and even reach the groin area. Kaposi sarcoma There are other types of cancers that can show up in people with HIV but perhaps the best known or most common is Kaposi’s sarcoma. This type of cancer causes dark lesions on the skin and the mucous membranes. It’s linked to the human herpesvirus 8 (HHV8), but the body’s immune system is usually able to keep the virus at bay. With HIV infection, the body’s immune system is compromised, and the infection can take hold. Other skin complaints Warts. Warts are one of the most common skin problems that people with HIV experience. They can range from 1 mm to 2 cm in diameter and can appear almost anywhere, including the mouth and genitals. Most are due to unregulated HPV infection. Molluscum contagiosum. If warts are incredibly common, molluscum contagiosum is, too. These translucent pustules can develop anywhere, but often cluster on the neck and face. Most people who get molluscum only get one or two lesions. Folks infected with HIV more often experience clusters of mollusca. Psoriasis. Another chronic inflammatory condition, psoriasis tends to causes your skin to develop thick red patches, which may then develop a scaly cover on top. The good news is that good management of your HIV has made it much easier to treat or control those annoying skin problems. For example, prurigo nodularis is much less common now among people who are receiving treatment for their HIV. But even if you have a good handle on your infection level, be sure to notify your doctor if you develop any new symptoms. It might be better to address something that seems minor and annoying before it can get worse—and you don’t want to overlook any other potentially problematic signs, either.