Pruritic papular eruption of HIV
Background
Clinical Features
Intensely pruritic papular rash with greatest severity on the extensor surfaces of extremities.
Pruritic papular eruptions as presenting illness of HIV.
Pruritic papular lesions on hands.
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
- CMV Retinitis
- Herpes Zoster Ophthalmicus
- 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.
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