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Antiretroviral treatment commenced within 30 hours of birth and continued until age 18 months.

Crusted Scabies

The combination of itching massive scaling suggests the diagnosis of crusted scabies. This variety of scabies is seen in those who are immunosuppressed or immunocompromised (typically HIV+). Repeated oral doses of ivermectin along with topical permethrin application were required to clear this infestation.

Topical treatment for oral candidiasis is not as effective when there is esophageal involvement. Topical treatments include nystatin, amphotericin B solution, and miconazole tablets. Systemic therapy given orally includes the azoles, of which fluconazole remains the most effective commonly prescribed. Voriconazole is effective against some resistant strains of Candida. Echinocandins, a newer class of drugs, inhibit cell wall synthesis.

Primary Syphilis

This painless, indurated ulcer is typical of the chancre of primary syphilis. This patient also had a positive RPR in a titer of 1:32.

Chlamydia trachomatis, serovar L2b-a recently discovered microbe-was the cause of atypical lymphogranuloma venereum in this HIV-positive patient.

Go-For-The-Glory Quiz

Skills quiz: Chondrodermatitis nodularis helices; Keratoses; OSA; Parotid swelling and HIV; Limbal flush

Syphilis is often called the "great imitator." The slides that follow show syphilis in various guises-and various disorders that can mimic the cutaneous manifestations of the sexually transmitted infection.