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Dry skin on palms and peripheral neuropathy
Jun 11, 2008

Hi Keith, hope this message finds you well. I'm a 30 yr old male writing from London. I have been on meds for four months. My first combo of Efavirenz and Kivexa lasted one month and I had to stop Efavirenz due to being spaced out all the time. My doc replaced this with Kaletra, so I have been on it 3 months almost. However, in the past 3 weeks the palms of my hands have become extremely dry - almost overnight - and the skin looks lined and wrinkled and taut. Additionally, the hands themselves are now becoming tender to touch and I am feelign much more sensation in them. I have noticed this starting in my feet too (not the dry skin here) and feeling tender. I am worried this could be neuropathy but realise it's not normally associated with this combo. Prior to this event I had very swollen glands in my neck and sore throat for a couple of weeks, but my doc said this could just be the immune system recompromising itself. He has referred me to adermatoogist but I am sure it is the meds. Have you come across this dry palm symptom before? Could it be neuropathy or even a abacavir hypersensity reaction (my gene test was negative)? I will ask to seem y doc again but value your opinion. Many Thanks, CAlvin

Response from Dr. Henry

Neuropathy (HIV or HIV drug realted) would rarely manifest itself initially as a palm rash/sensation. Likewise that would be unusual to be due to abacavir or the lamivudine in Kexiva (Epzicom in the US). Syphilis and other non-HIV related conditions need to be considered so the dermatology consultation is a good move.

Here is one list I grabbed for possible causes of palm rash/skin changes:

* Heat rash * Contact dermatitis * Stasis dermatitis (type of Eczema) * Seborrheic dermatitis * Measles * Venous insufficiency * Chickenpox * HIV infection * Nummular eczema (type of Eczema) * Dry skin * Bacterial meningitis * Melanoma * Skin cancer * Q fever * Syphillis * Ichthyosis * Erythema nodosum * Pyoderma gangrenosum

I would concur with your HIV doc that immune reconstitution can also cause some strange flare up of skin conditions. Let us know what is found/outcome. KH

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