International Journal of Trichology

: 2014  |  Volume : 6  |  Issue : 4  |  Page : 153-

Dermato-trichologist and acquired immuno-deficiency syndrome

Patrick Yesudian 
 President, The Hair Research Society of India, No. 10, Richardson Avenue, Vepery, Chennai - 600 007, India

Correspondence Address:
Patrick Yesudian
President, The Hair Research Society of India, No. 10, Richardson Avenue, Vepery, Chennai - 600 007

How to cite this article:
Yesudian P. Dermato-trichologist and acquired immuno-deficiency syndrome.Int J Trichol 2014;6:153-153

How to cite this URL:
Yesudian P. Dermato-trichologist and acquired immuno-deficiency syndrome. Int J Trichol [serial online] 2014 [cited 2023 Mar 27 ];6:153-153
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Full Text

Throughout recorded history, epidemics have ravaged the human race. More than wars and natural disasters such as tsunamis and earthquakes, infections are responsible for much human misery and death. The three great epidemics of the past with predominant skin lesions were plague, smallpox and syphilis. The present pandemic of acquired immuno-deficiency syndrome (AIDS) is also inextricably intertwined with muco-cutaneous lesions.

Hair changes could be important manifestations of both syphilis and AIDS and their unholy combination. As medical students in the 50's, we were taught to consider syphilis in the differential diagnosis of any patient who presents with alopecia, be it scarring or non-scarring.

Acquired immuno-deficiency syndrome patients often report to the dermato-trichologist for severe seborrheic dermatitis. The severe seborrheic dermatitis is probably due to the unrestrained proliferation of Malassezia globosa caused by the immuno-suppression. Changes in surface lipid composition have also been noted in AIDS patients with seborrheic dermatitis. Exacerbation of scalp psoriasis that is very common in them may pose a diagnostic dilemma.

Although massive colonization of malassezia makes it rare, extensive tinea capitis with hair loss, and scalp infection with scopulariopsis brevicaulis causing severe alopecia have been recorded in human immune-deficiency virus (HIV) infected patients.

Unsightly large mollusca are commonly seen on the scalp. Kaposi's sarcoma on the scalp has been reported.

Besides infections, there is a volley of hair changes. In colored races with AIDS, alterations in hair pattern in the form of hairs becoming longer, Softer, silkier and at times discolored may occur. Interestingly spontaneous straightening of hairs has been occasionally reported in this ethnic group, long eyelashes, termed trichomegaly, indicate late stage disease where the CD4 cell count is less than 250/ml.×

Typical alopecia areata recovering after zidovudine therapy has been noted at times. Sudden graying of hairs and telogen effluvium suffered by some may only be a reflection of the general catabolic changes and psychological stress undergone by HIV-positive patients. Women with AIDS have finer hair when compared with HIV-negative peers.

The financial and psychological burden on a patient with AIDS is immeasurable and the hair changes, which constitute only a narrow spectrum of the wide repertoire of muco-cutaneous manifestations, would add a further dimension to the misery of these individuals. Trichologists could play an important role in alleviating this misery.