Pruritic papular eruption of HIV: Difference between revisions
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==Background== | ==Background== | ||
*Most common rash of HIV<ref>Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: an institutional urban clinic experience. Zancanaro PC et al. J Am Acad Dermatol. 2006 Apr;54(4):581-8.</ref> | *Most common [[rash]] of [[HIV]]<ref>Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: an institutional urban clinic experience. Zancanaro PC et al. J Am Acad Dermatol. 2006 Apr;54(4):581-8.</ref> | ||
*Presenting symptom of HIV in up to ~80% cases | *Presenting symptom of HIV in up to ~80% cases | ||
*3x more common when CD4 count < 200 | *3x more common when CD4 count < 200 | ||
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==Clinical Features== | ==Clinical Features== | ||
*Pruritic | *[[Pruritus|Pruritic]] | ||
*Diffusely, symmetrically distributed rash | *Diffusely, symmetrically distributed [[rash]] | ||
*Discrete red bumps initially | **Discrete red bumps initially | ||
*Extremities/trunk > face | **Extremities/trunk > face | ||
*Mucous membrane sparing | **Mucous membrane sparing | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Folliculitis]] | *[[Folliculitis]] | ||
*[[Cellulitis]] | *[[Cellulitis]] | ||
*Fungal infection | *[[Fungal infection]] | ||
*HSV infection | *[[HSV]] infection | ||
*HPV warts | *[[HPV]] warts | ||
*Drug reaction | *[[drug rash|Drug reaction]] | ||
*Insect bites | *[[Insect bites]] | ||
*[[Porphyria]] | *[[Porphyria]] | ||
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==Management== | ==Management== | ||
*Initially topical steroids, emollients, PO antihistamines | *Initially [[topical steroids]], emollients, PO [[antihistamines]] | ||
*[[Doxepin]] 25 mg QHS later line PO med for those without TCA contraindication<ref>Maurer. Dermatologic Manifestations of HIV Infection. Perspective – Dermatologic Manifestations Volume 13 Issue 5 December 2005/January 2006.</ref> | *[[Doxepin]] 25 mg QHS later line PO med for those without TCA contraindication<ref>Maurer. Dermatologic Manifestations of HIV Infection. Perspective – Dermatologic Manifestations Volume 13 Issue 5 December 2005/January 2006.</ref> | ||
*UV phototherapy for refractory cases | *UV phototherapy for refractory cases | ||
Revision as of 01:10, 28 September 2019
Background
- Most common rash of HIV[1]
- Presenting symptom of HIV in up to ~80% cases
- 3x more common when CD4 count < 200
- Up to 46% of HIV patients have this rash at some time of disease course
- Diagnosis of exclusion
Clinical Features
- Pruritic
- Diffusely, symmetrically distributed rash
- Discrete red bumps initially
- Extremities/trunk > face
- Mucous membrane sparing
Differential Diagnosis
- Folliculitis
- Cellulitis
- Fungal infection
- HSV infection
- HPV warts
- Drug reaction
- Insect bites
- Porphyria
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[2]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
- Appropriate clinical setting
Management
- Initially topical steroids, emollients, PO antihistamines
- Doxepin 25 mg QHS later line PO med for those without TCA contraindication[3]
- UV phototherapy for refractory cases
Disposition
- Outpatient dermatology follow up
- Average time for recurrence of skin condition ~8 wks
References
- ↑ Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: an institutional urban clinic experience. Zancanaro PC et al. J Am Acad Dermatol. 2006 Apr;54(4):581-8.
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
- ↑ Maurer. Dermatologic Manifestations of HIV Infection. Perspective – Dermatologic Manifestations Volume 13 Issue 5 December 2005/January 2006.