Pruritic papular eruption of HIV

Background

• Most common rash of HIV
• Presenting symptom of HIV in up to ~80% cases
• 3x more common when CD4 count < 200
• Up to 46% of HIV pts have this rash at some time
• Diagnosis of exclusion

Clinical Features

• Pruritic
• Diffusely, symmetrically distributed rash
• Discrete red bumps initially
• Extremities/trunk > face
• Mucous membrane sparing

Differential

• Folliculitis
• Cellulitis
• Fungal infection
• HSV infection
• HPV warts
• Drug reaction
• Insect bites
• Porphyria

Treatments

• Initially topical steroids, emollients, PO antihistamines
• UV phototherapy for refractory cases

Disposition

• Outpatient dermatology f/u
• Average time for recurrence of skin condition ~8 wks

Sources

• Tallon B. Pruritic papular eruption of HIV. DermNet NZ. http://www.dermnetnz.org/viral/papulopruritic-hiv.html.
• 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.
• Schwartz RA et al. Cutaneous Manifestations of HIV. eMedicine. Updated Apr 27, 2015. http://emedicine.medscape.com/article/1133746-overview#showall.