UMEM Educational Pearls

Category: International EM

Title: What's the diagnosis?

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

Posted: 4/1/2014 by Andrea Tenner, MD (Emailed: 4/2/2014) (Updated: 4/2/2014)
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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?




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)  


  • 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.  
  • 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



HIV-Associated_Puritic_Papular_Eruptions.JPG (2,920 Kb)