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Table of Contents
HIV Rash
Treatment
When to See a Provider
An HIV rash is a common symptom among people living with human immunodeficiency virus (HIV). In addition to a rash that appears as an early sign of HIV, you may be at risk for other types of rashes if you have HIV.
Around 90% of people with HIV will experience skin conditions related to the virus at some point.These conditions can cause itching, red bumps, pain, and more. Pictures of the types of possible rashes with HIV can help you better understand the rashes associated with the virus.
A painful or itchy rash may be one of thefirst symptoms of HIV. This rash typically appears as a flat, red rash. The rash may appear anywhere from two to six weeks after exposure to the virus.Features of this rash include the following:
On light skin, the rash may look reddish, flushed, or discolored. On dark skin, it may be deep purple. Skin and rash appearance in individuals with HIV can vary widely.
Along with other early signs of the virus, an HIV rash may last for only a few days or up to several weeks.
U.S. National Library of Medicine / National Institutes of Health
Other Warning Signs or Symptoms of HIVA rash is one of the symptoms associated with a new and recent HIV infection. Several weeks after exposure to HIV, your body produces HIV-specific antibodies (specific proteins) that a blood test candetect.Other symptoms that can accompany this rash include:Flulike symptoms, such as fever, body aches, and chillsSwollen lymph nodesDiarrheaHeadacheWeight lossSwollen lymph nodesNight sweatsSore throatMouth ulcers
Other Warning Signs or Symptoms of HIV
A rash is one of the symptoms associated with a new and recent HIV infection. Several weeks after exposure to HIV, your body produces HIV-specific antibodies (specific proteins) that a blood test candetect.Other symptoms that can accompany this rash include:Flulike symptoms, such as fever, body aches, and chillsSwollen lymph nodesDiarrheaHeadacheWeight lossSwollen lymph nodesNight sweatsSore throatMouth ulcers
A rash is one of the symptoms associated with a new and recent HIV infection. Several weeks after exposure to HIV, your body produces HIV-specific antibodies (specific proteins) that a blood test candetect.Other symptoms that can accompany this rash include:
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HIV affects the immune system, so healthcare providers use several tests to monitor the immune system in individuals living with HIV. One blood count providers watch is theCD4 cell count.
CD4 cells are white blood cells essential in fighting infection. As HIV progresses, the CD4 count may drop. Individuals withlower CD4 countsare more prone to opportunistic infections, including various skin conditions.
Many of these skin conditions may present with a more severe presentation due to the individual’s compromised immune system. They may also present atypically or differently than in individuals who are otherwise healthy.
Additionally, it can be more challenging to treat rashes and skin conditions in those with HIV, and rashes may require multiple courses of treatment to be effective.
Rashes and skin conditions in individuals with HIV may include but are not limited to,inflammatory skin conditions, such as:
Infectious causes of rashes may include, but are not limited to:
Additionally, individuals with HIV are much more likely to experience skin-related side effects of medications. As immune function decreases, the likelihood of experiencing a skin-related side effect from medication increases.
Seborrheic Dermatitis
doble-d / Getty Images.
Seborrheic dermatitis is common in people with HIV, most often occurring in the early stages when blood counts of CD4 (white blood cells that are important to fighting infections) are at around 400.
Seborrheic dermatitis occurs on areas of the skin where there are manysebaceous (oil) glands, such as the scalp. In people with HIV, seborrheic dermatitis often presents much more severely. It is also likely to be diffuse (spread over a large area).
Treatment will vary depending on severity. Adults and children with mild cases of seborrheic dermatitis are treated with topicalketoconazole2%, which is anantifungal cream,as well as topical corticosteroids.
Eosinophilic Folliculitis
© 2018 Indian Journal of Sexually Transmitted Diseases and AIDS
Eosinophilic folliculitis(EF) is an inflammatory skin condition. In people with HIV, it is one of the most common skin conditions and usually occurs when a person’s CD4 count is under 250.
Symptoms of eosinophilic folliculitis can include:
Eosinophilic folliculitis typically affects the face, scalp, neck, and trunk.
It can be treated with:
Theories on the cause of HIV-related eosinophilic folliculitis includefungal infections, bacterial infections, andDemodex folliculorum, a type of mite.It’s also thought that EF may be an autoimmune reaction tosebum, or oil in the skin. Yet research findings for these causes have been inconsistent.
Antiretroviral therapy (ART) remains the cornerstone treatment of HIV and often gives the best, most-lasting results when treating skin conditions arising from HIV infection.
Papular Pruritic Rash
This photo contains content that some people may find graphic or disturbing.See PhotoAmerican Academy of Family Physicians
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
American Academy of Family Physicians
A papular pruritic rash is quite common in people with HIV. One study of 100 HIV-positive people with itchy rash symptoms reported the diagnosis in 11.3% of cases.It is more common in advanced stages of HIV, typically occurring when a person’s CD4 count is under 200.
Treatment includes antihistamines and topical corticosteroids, as well as:
Other conditions in which papular pruritic rash is common include:
A CD4 count below 200 is classified as AIDS, the most advanced stage of an HIV infection.
Xerosis
This photo contains content that some people may find graphic or disturbing.See Photo© 2021, StatPearls Publishing LLC.
© 2021, StatPearls Publishing LLC.
Topical lotions and creams can be used to treat the skin, some of which require a prescription from a healthcare provider.
Prurigo Nodularis
Prurigo nodularis.© 2017 Indian Journal of Sexually Transmitted Diseases and AIDS
© 2017 Indian Journal of Sexually Transmitted Diseases and AIDS
Prurigo nodularisis a skin condition that causes extremely itchy and symmetrical papulonodular lesions, usually on the extensor surfaces of the arms and legs.
Its cause is still unknown, but it’s believed to be due to a variety of factors, including immune responses and neural dysfunction. Prurigo nodularis can also occur with other skin conditions, most oftenatopic dermatitis(eczema).
Treatment options include:
If someone with HIV develops prurigo nodularis, they should be monitored for the development ofneuropathy(nerve pain).
Rashes in People Living With HIVSome rash-like conditions, such as lesions common with a cancer calledKaposi’s sarcoma, are common in people living with HIV/AIDS. Others, like a thrush infection, can affect other people but are considered AIDS-defining because of how they affect people diagnosed with HIV.
Rashes in People Living With HIV
Some rash-like conditions, such as lesions common with a cancer calledKaposi’s sarcoma, are common in people living with HIV/AIDS. Others, like a thrush infection, can affect other people but are considered AIDS-defining because of how they affect people diagnosed with HIV.
Cytomegalovirus (CMV) Rash
An opportunistic infection (OI) affects people with weakened immune systems, while an AIDS-defining condition indicates that someone has AIDS.Cytomegalovirus(CMV) is one of 24 AIDS-defining conditions that typically occur when the CD4 count is under 100.
CMVappears as small, elevated, purpuric, reddish papules and macules. CMV may appear to manifest as other lesions, such as nonhealing perianal or vulvar ulcers. Diagnostic testing will differentiate a CMV rash from aherpes simplexorvaricella zoster(causing chicken pox and herpes zoster) infection.
Chronic CMV infection is treated with Zigran (ganciclovir), an antiviral drug.
Kaposi sarcoma
Kaposi sarcoma (KS) is a type of cancer that affects the lining of blood vessels. It typically appears as skin tumors or tumors on mucosal surfaces (e.g., inside the mouth). However, it can also appear in other places, such as lymph nodes or the digestive tract.
While there are a few different types of KS, one variant is primarily seen in individuals with HIV. There are several different treatments for KS, including chemotherapy, radiation, and immunotherapy. Additionally, adherence to medications for HIV can also help to control the spread.
Drug hypersensitivityis an adverse immune system reaction to medication. Given the many drugs used to manage the infection, people with HIV are at higher risk of developing drug hypersensitivity.
Mild cases of drug hypersensitivity typically involve a maculopapular rash with a delayedallergic reaction, usually appearing between one to six weeks.
Several of the medications used to treat HIV may cause a mild or moderate rash. Examples of drugs that can cause a rash include non-nucleoside reverse transcriptase inhibitors (NNRTIs) and Darunavir (DRV).
In most cases, mild rashes will resolve without needing to switch medications. However, if the medication that caused the rash is Nevirapine (NVP), it is more likely to require a medication switch. If you do develop a rash after beginning a new medication for HIV or at any point in your treatment, consult your healthcare provider for advice.
Drug hypersensitivity is 100 times more common in people with HIV.
Stevens-Johnson Syndrome/Toxic Epidermal Necrosis
This photo contains content that some people may find graphic or disturbing.See PhotoU.S. National Library of Medicine / National Institutes of Health
Stevens-Johnson syndrome (SJS) andtoxic epidermal necrolysis (TEN)are severe forms of drug hypersensitivity. SJS is defined as skin involvement of less than 10%, while TEN is defined as skin involvement of greater than 30%.
Complications includesepsisand organ failure. Drugs most commonly associated with SJS and TEN in people with HIV include:
Treatment also includes:
Signs of an EmergencyIf you suspect that you have SJS or TEN, call 911 or see your healthcare provider right away.
Signs of an Emergency
If you suspect that you have SJS or TEN, call 911 or see your healthcare provider right away.
HIV Rash Treatment
Treatment for an HIV rash depends on the type of rash. You may also need to consider other underlying health issues. Discuss proper treatments with your healthcare provider. For early-stage HIV rashes, they may recommendhydrocortisone creamto help relieve the itching and swelling.
Avoiding hot showers and direct sunlight can also help prevent further irritation to skin rashes.
For some rashes, antiretroviral treatment can relieve symptoms or help prevent the development of other types of skin problems.
When to See a Healthcare Provider
If you have already been diagnosed with HIV, see a healthcare provider anytime you develop a rash so they can determine whether the rash is related to HIV or another cause.
For those who have not been diagnosed, see a healthcare provider right away if you think you have been exposed to HIV, even if you do not have a rash or other early symptoms. You may be able to receiveHIV postexposure prophylaxis (PEP) treatmentswithin 72 hours of exposure, which can protect you from developing HIV.
When you see your healthcare provider, they will run anHIV test. This usually consists of taking a blood or saliva sample. This will be done whether you show symptoms or are concerned that you may have been infected.
If the preliminary test is positive, your healthcare provider will perform another more sensitive test to confirm the result.
Summary
A rash can be a cause and an effect of an HIV infection. If someone has HIV and develops a rash, they should begin antiretroviral therapy as soon as possible to mitigate the effects.
Starting ART as soon as you learn of your HIV diagnosis is imperative in reducing the risk of disease progression, severe complications, and premature death. HIV is a treatable condition. Talk to your healthcare provider about any concerns you may have.
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26 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organization.Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults.Garg T, Sanke S.Inflammatory dermatoses in human immunodeficiency virus.Indian J Sex Transm Dis AIDS. 2017;38(2):113-120. doi:10.4103/ijstd.IJSTD_22_17Altman K, Vanness E, Westergard RP.Cutaneous manifestations of human immunodeficiency virus: a clinical update.Curr Infect Dis Rep.2015;17(3):464. doi:10.1007/s11908-015-0464-yNIH.HIV and AIDS: the basics.Triebelhorn J, Haschka S, Hesse F, Erber J, Weidlich S, Lee M,et al.Acute HIV infection syndrome mimicking COVID-19 vaccination side effects: a case report.AIDS Res Ther. 2021 Oct 26;18(1):78. doi:10.1186/s12981-021-00407-2.HIV.gov.Symptoms of HIV.MedlinePlus.CD4 lymphocyte count.Garg T, Sanke S.Inflammatory dermatoses in human immunodeficiency virus.Indian J Sex Transm Dis AIDS. 2017;38(2):113-120.National Center for Advancing Translational Sciences.Eosinophilic pustular folliculitis.National Institutes of Health.Eosinophilic pustular folliculitis.UpToDate.HIV-associated eosinophilic folliculitis.Mohammed S, Vellaisamy SG, Gopalan K, Sukumaran L, Valan AS.Prevalence of pruritic papular eruption among HIV patients: A cross-sectional study.Indian J Sex Transm Dis AIDS. 2019 Jul-Dec;40(2):146-151. doi: 10.4103/ijstd.IJSTD_69_18.Agyei M, Ofori A, Tannor EK, Annan JJ, Norman BR.A forgotten parasitic infestation in an immunocompromised patient-a case report of crusted scabies.Pan Afr Med J. 2020 Aug 4;36:238. doi:10.11604/pamj.2020.36.238.24288National Institutes of Health.Stages of HIV Infection.Mancy, A.Handbook of Appearances in Clinical Dermatology.National Eczema Association.Prescription topicals.Warrier SA, Sathasivasubramanian S.Human immunodeficiency virus induced oral candidiasis.J Pharm Bioallied Sci. 2015;7(Suppl 2):S812-S814. doi:10.4103/0975-7406.163577U.S. Department of Veteran Affairs.AIDS-defining illnesses.Märtson AG, Edwina AE, Kim HY, Knoester M, Touw DJ, Sturkenboom MGG,et al.Therapeutic Drug Monitoring of Ganciclovir: Where Are We?Ther Drug Monit. 2022 Feb 1;44(1):138-147. doi:10.1097/FTD.0000000000000925.American Cancer Society.What is Kaposi sarcoma?American Cancer Society.Treating Kaposi sarcoma.Yunihastuti E, Widhani A, Karjadi TH.Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management.Asia Pac Allergy. 2014;4(1):54-67. doi:10.5415/apallergy.2014.4.1.54NIH.Adverse effects of antiretroviral agents.Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T.Current perspectives on stevens-johnson syndrome and toxic epidermal necrolysis.Clin Rev Allergy Immunol. 2018;54(1):147-176. doi:10.1007/s12016-017-8654-zOakley AM, Krishnamurthy K.Stevens johnson syndrome. In:StatPearls. StatPearls PublishingCenters for Disease Control and Prevention.Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injecting drug use, or other nonoccupational exposure to HIV—United States, 2016.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
World Health Organization.Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults.Garg T, Sanke S.Inflammatory dermatoses in human immunodeficiency virus.Indian J Sex Transm Dis AIDS. 2017;38(2):113-120. doi:10.4103/ijstd.IJSTD_22_17Altman K, Vanness E, Westergard RP.Cutaneous manifestations of human immunodeficiency virus: a clinical update.Curr Infect Dis Rep.2015;17(3):464. doi:10.1007/s11908-015-0464-yNIH.HIV and AIDS: the basics.Triebelhorn J, Haschka S, Hesse F, Erber J, Weidlich S, Lee M,et al.Acute HIV infection syndrome mimicking COVID-19 vaccination side effects: a case report.AIDS Res Ther. 2021 Oct 26;18(1):78. doi:10.1186/s12981-021-00407-2.HIV.gov.Symptoms of HIV.MedlinePlus.CD4 lymphocyte count.Garg T, Sanke S.Inflammatory dermatoses in human immunodeficiency virus.Indian J Sex Transm Dis AIDS. 2017;38(2):113-120.National Center for Advancing Translational Sciences.Eosinophilic pustular folliculitis.National Institutes of Health.Eosinophilic pustular folliculitis.UpToDate.HIV-associated eosinophilic folliculitis.Mohammed S, Vellaisamy SG, Gopalan K, Sukumaran L, Valan AS.Prevalence of pruritic papular eruption among HIV patients: A cross-sectional study.Indian J Sex Transm Dis AIDS. 2019 Jul-Dec;40(2):146-151. doi: 10.4103/ijstd.IJSTD_69_18.Agyei M, Ofori A, Tannor EK, Annan JJ, Norman BR.A forgotten parasitic infestation in an immunocompromised patient-a case report of crusted scabies.Pan Afr Med J. 2020 Aug 4;36:238. doi:10.11604/pamj.2020.36.238.24288National Institutes of Health.Stages of HIV Infection.Mancy, A.Handbook of Appearances in Clinical Dermatology.National Eczema Association.Prescription topicals.Warrier SA, Sathasivasubramanian S.Human immunodeficiency virus induced oral candidiasis.J Pharm Bioallied Sci. 2015;7(Suppl 2):S812-S814. doi:10.4103/0975-7406.163577U.S. Department of Veteran Affairs.AIDS-defining illnesses.Märtson AG, Edwina AE, Kim HY, Knoester M, Touw DJ, Sturkenboom MGG,et al.Therapeutic Drug Monitoring of Ganciclovir: Where Are We?Ther Drug Monit. 2022 Feb 1;44(1):138-147. doi:10.1097/FTD.0000000000000925.American Cancer Society.What is Kaposi sarcoma?American Cancer Society.Treating Kaposi sarcoma.Yunihastuti E, Widhani A, Karjadi TH.Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management.Asia Pac Allergy. 2014;4(1):54-67. doi:10.5415/apallergy.2014.4.1.54NIH.Adverse effects of antiretroviral agents.Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T.Current perspectives on stevens-johnson syndrome and toxic epidermal necrolysis.Clin Rev Allergy Immunol. 2018;54(1):147-176. doi:10.1007/s12016-017-8654-zOakley AM, Krishnamurthy K.Stevens johnson syndrome. In:StatPearls. StatPearls PublishingCenters for Disease Control and Prevention.Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injecting drug use, or other nonoccupational exposure to HIV—United States, 2016.
World Health Organization.Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults.
Garg T, Sanke S.Inflammatory dermatoses in human immunodeficiency virus.Indian J Sex Transm Dis AIDS. 2017;38(2):113-120. doi:10.4103/ijstd.IJSTD_22_17
Altman K, Vanness E, Westergard RP.Cutaneous manifestations of human immunodeficiency virus: a clinical update.Curr Infect Dis Rep.2015;17(3):464. doi:10.1007/s11908-015-0464-y
NIH.HIV and AIDS: the basics.
Triebelhorn J, Haschka S, Hesse F, Erber J, Weidlich S, Lee M,et al.Acute HIV infection syndrome mimicking COVID-19 vaccination side effects: a case report.AIDS Res Ther. 2021 Oct 26;18(1):78. doi:10.1186/s12981-021-00407-2.
HIV.gov.Symptoms of HIV.
MedlinePlus.CD4 lymphocyte count.
Garg T, Sanke S.Inflammatory dermatoses in human immunodeficiency virus.Indian J Sex Transm Dis AIDS. 2017;38(2):113-120.
National Center for Advancing Translational Sciences.Eosinophilic pustular folliculitis.
National Institutes of Health.Eosinophilic pustular folliculitis.
UpToDate.HIV-associated eosinophilic folliculitis.
Mohammed S, Vellaisamy SG, Gopalan K, Sukumaran L, Valan AS.Prevalence of pruritic papular eruption among HIV patients: A cross-sectional study.Indian J Sex Transm Dis AIDS. 2019 Jul-Dec;40(2):146-151. doi: 10.4103/ijstd.IJSTD_69_18.
Agyei M, Ofori A, Tannor EK, Annan JJ, Norman BR.A forgotten parasitic infestation in an immunocompromised patient-a case report of crusted scabies.Pan Afr Med J. 2020 Aug 4;36:238. doi:10.11604/pamj.2020.36.238.24288
National Institutes of Health.Stages of HIV Infection.
Mancy, A.Handbook of Appearances in Clinical Dermatology.
National Eczema Association.Prescription topicals.
Warrier SA, Sathasivasubramanian S.Human immunodeficiency virus induced oral candidiasis.J Pharm Bioallied Sci. 2015;7(Suppl 2):S812-S814. doi:10.4103/0975-7406.163577
U.S. Department of Veteran Affairs.AIDS-defining illnesses.
Märtson AG, Edwina AE, Kim HY, Knoester M, Touw DJ, Sturkenboom MGG,et al.Therapeutic Drug Monitoring of Ganciclovir: Where Are We?Ther Drug Monit. 2022 Feb 1;44(1):138-147. doi:10.1097/FTD.0000000000000925.
American Cancer Society.What is Kaposi sarcoma?
American Cancer Society.Treating Kaposi sarcoma.
Yunihastuti E, Widhani A, Karjadi TH.Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management.Asia Pac Allergy. 2014;4(1):54-67. doi:10.5415/apallergy.2014.4.1.54
NIH.Adverse effects of antiretroviral agents.
Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T.Current perspectives on stevens-johnson syndrome and toxic epidermal necrolysis.Clin Rev Allergy Immunol. 2018;54(1):147-176. doi:10.1007/s12016-017-8654-z
Oakley AM, Krishnamurthy K.Stevens johnson syndrome. In:StatPearls. StatPearls Publishing
Centers for Disease Control and Prevention.Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injecting drug use, or other nonoccupational exposure to HIV—United States, 2016.
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