Pruritic papular eruption of HIV
Background
Clinical Features
Differential Diagnosis
- Folliculitis
- Cellulitis
- Fungal infection
- HSV infection
- HPV warts
- Drug reaction
- Insect bites
- Porphyria
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Pneumocystis jirovecii pneumonia (PCP)
- Tuberculosis (TB)
- CMV pneumonia
- 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.
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