psoriasis / broken skin

Question

Hello Doctor,

Thanks for all of your advice in this forum. I've been reading through the archives, and your patience, humor and compassion have been a real reassurance to many, myself included. So... as for patience, hopefully I won't be taxing yours too much with this question. I've read over and over that the theoretical risk of environmental HIV transmission through "casual contact" (i. e. the usual suspects: door knobs, toilet seats, etc.) is essentially zero, and that unbroken skin is a good barrier against transmission. What kind of increased risk from casual contact, if any, is there for those who suffer from psoriasis (like myself), eczema, etc.? The psoriasis can itch like crazy sometimes, so often I end up scratching a particular spot until it's bloody, without even thinking about it. I've read that there have been one or two isolated cases of transmission in medical workplace or home care settings through skin lesions from dermatitis but, as I understand, these were the result of direct physical contact with infected blood or other fluids. And any definition of "percutaneous transmission" that I've read has been pretty vague. Obviously I can see where a needle stick or cut could be a transmission route, but does the skin still retain some effective measure of integrity as a barrier, even with a condition like psoriasis--and all of that bloody scratching?

I apologize for asking essentially the same old question ONE MORE TIME... But aside from the cases of direct blood-to-lesion transmission that have been documented, I 've never really found any info that addresses casual contact with less-than-intact skin. Any insight is well appreciated. Thanks in advance.

Answer

Hi,

Your question almost qualified for QTND (Questions That Never Die) status, but not quite, because you are at least wondering about "less-than-intact skin" casual contact rather than just casual contact. The reason you weren't able to find information about this specific topic is that it really doesn't exist. The reason it doesn't exist is because "casual contact," such as hugging, touching, coming into contact with sweat or tears, etc. with or without less-than-intact skin does not transmit HIV.

The direct contact of not-intact skin with infected blood does pose an HIV risk, as you mentioned.

Stay well. See a dermatologist if you're scratching holes in yourself!

Dr. Bob