Question
You are working in a clinic in Tanzania (or Baltimore, for that matter) when a 24 year old presents with this itchy rash on his feet. What's the diagnosis and what underlying systemic condition does it indicate?
Answer
Pruritic Papular Eruptions in HIV
- The most common cutaneous manifestation of HIV.
- The presenting symptom of HIV in 25-75% of patients and can be the initial indicator of advanced immunosuppression (the rash typically occurs once a patients CD4 is < 200)
Presentation:
- Multiple, discrete red bumps, which are puritic, symmetric and diffusely distributed.
- Typically seen on the extremities and trunk with sparing of the mucous membranes, palms and webspaces.
Treatment:
- Topical steroids, emollients, and antihistamines are first line therapies.
- If this fails, a trial of phototherapy is appropriate. However, PPE has been found to be resistant to most of these treatments.
University of Maryland Section for Global Emergency Health
Authors: Van Pham, MD and Colleen Holley, MD
References
http://dermnetnz.org/viral/