Pruritic papular eruption of HIV
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.