UMEM Educational Pearls

Title: What's the diagnosis?

Keywords: HIV, global health, infectious disease, rash, puritis (PubMed Search)

Posted: 4/1/2014 by Andrea Tenner, MD (Updated: 4/2/2014)
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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/papulopruritic-hiv.html

Attachments

1404012249_HIV-Associated_Puritic_Papular_Eruptions.JPG (2,920 Kb)