Pruritic Papular Eruption HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicinePruritic Papular Eruption HIVSCE Infectious Diseases

A 28-year-old man with HIV (CD4 350, VL <50 on ART) presents with pruritic papular eruption (PPE) — multiple pruritic papules on his trunk and extremities that have been present for months. Skin biopsy shows perivascular eosinophilic infiltrate. All infectious workup is negative. What is this condition?

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Correct answer: D — Pruritic papular eruption of HIV — a chronic eosinophilic dermatosis specific to HIV that may persist even with effective ART; treatment is topical corticosteroids and antihistamines

PPE of HIV is a chronic pruritic dermatosis characterised by symmetrical papules on the trunk and proximal extremities, with eosinophilic perivascular infiltrate on biopsy. It can occur at any CD4 count but is more common at lower counts. It may persist despite effective ART. Management: topical corticosteroids (moderate potency), antihistamines, phototherapy (UVB) for refractory cases. It is distinct from eosinophilic folliculitis (which shows follicular-centred pustules) and scabies (which shows burrows and has different distribution). The negative infectious workup excludes secondary causes.

Reference: BHIVA 2022 – Dermatological conditions in HIV; BAD 2023