Types of HIV Rash

Rashes are a common symptom associated with an infection with the human immunodeficiency virus (HIV). In fact, around 90% of people with HIV will experience a rash at some point during the course of their infection. Some rashes are the result of HIV itself, and others are caused by opportunistic infections (OIs) or by the medications taken to treat HIV.

HIV Symptoms

Most people don’t know right away when they’ve been infected with HIV. But they may have symptoms within 2 to 6 weeks after they’ve gotten the virus. This is when your body’s immune system puts up a fight. It’s called acute retroviral syndrome or primary HIV infection.

The symptoms are similar to those of other viral illnesses, and they’re often compared to the flu. They typically last a week or two and then go away. Early signs of HIV include:

• Headache
• Fatigue
• Aching muscles
• Sore throat
• Swollen lymph nodes
• A red rash that doesn’t itch, usually on your torso
• Fever
• Ulcers (sores) in your mouth, esophagus, anus, or genitals
• Headache and other neurological symptoms

If you have symptoms like these and might have come into contact with someone with HIV in the past 2 to 6 weeks, go to a doctor and ask that you get an HIV test. If you don’t have symptoms but still think you might have come into contact with the virus, get tested.

Early testing is important for two reasons. First, at this stage, levels of HIV in your blood and bodily fluids are very high. This makes it especially contagious. Second, starting treatment as soon as possible might help boost your immune system and ease your symptoms.

A combination of medications (called HIV drugs, antiretroviral therapy, or ART) can help fight HIV, keep your immune system healthy, and keep you from spreading the virus. If you take these medications and have healthy habits, your HIV infection probably won’t get worse.

Second Stage: Clinical Latency Symptoms

After your immune system loses the battle with HIV, the flu-like symptoms will go away. But there’s a lot going on inside your body. Doctors call this the asymptomatic period or chronic HIV infection.

In your body, cells called CD4 T cells coordinate your immune system’s response. During this stage, untreated HIV will kill CD4 cells and destroy your immune system. Your doctor can check how many of these cells you have with blood tests. Without treatment, the number of CD4 cells will drop, and you’ll be more likely to get other infections.

Most people don’t have symptoms they can see or feel. You may not realize that you’re infected and can pass HIV on to others.

If you’re taking ART, you might stay in this phase for decades. You can pass the virus on to other people, but it’s extremely rare if you take your medicines.

Third Stage: AIDS Symptoms

AIDS is the advanced stage of HIV infection. This is usually when your CD4 T-cell number drops below 200 and your immune system is badly damaged. You might get an opportunistic infection, an illness that happens more often and is worse in people who have weakened immune systems. Some of these, such as Kaposi’s sarcoma (a form of skin cancer) and pneumocystis pneumonia (a lung disease), are also considered “AIDS-defining illnesses.”

If you didn’t know earlier that you were infected with HIV, you may realize it after you have some of these symptoms:

• Being tired all the time
• Swollen lymph nodes in your neck or groin
• Fever that lasts more than 10 days
• Night sweats
• Weight loss with no obvious reason
• Purplish spots on your skin that don’t go away
• Shortness of breath
• Severe, long-lasting diarrhea
• Yeast infections in your mouth, throat, or vagina
• Bruises or bleeding you can’t explain
• Neurological symptoms such as memory loss, confusion, balance problems, behavior changes, seizures, and vision changes

People with AIDS who don’t take medication live about 3 years, or less if they get another infection. But HIV can still be treated at this stage. If you start on HIV drugs, stay on them, follow your doctor’s advice, and keep healthy habits, you can live a long time.

Show Sources

World Health Organization: “HIV Infection.”

CDC: “HIV/AIDS,” “About HIV/AIDS,” “AIDS and Opportunistic Infections.”

AIDS.gov: “Stage of HIV Infection.”

Betts, R. A Practical Approach to Infectious Diseases, Lippincott Williams & Wilkins, fifth edition, 2005.

Heymann, D. Control of Communicable Diseases Manual, 18th edition.

American Public Health Association, Washington, D.C., 2004.

Lashley, F. Emerging Infectious Diseases: Trends and Issues, Springer Publishing, 2004.

HIV.gov: “Symptoms of HIV.”

UpToDate: “Patient education: HIV/AIDS (Beyond The Basics),” “Acute and early HIV infection: Treatment.”

Mayo Clinic: “HIV/AIDS.”

U.S. National Library of Medicine: “HIV and Opportunistic Infections, Coinfections, and Conditions,” “CD4 T Lymphocyte.”

UCSF Health: “HIV Signs and Symptoms,” “AIDS Signs and Symptoms.”

Types of HIV Rash

Molly Burford is a mental health advocate and wellness book author with almost 10 years of experience in digital media.

Published on October 04, 2021

Latesha Elopre, MD, is a board-certified internist specializing in HIV. She is an assistant professor of infectious diseases at the University of Alabama at Birmingham.

Table of Contents
Table of Contents

Rashes are a common symptom associated with an infection with the human immunodeficiency virus (HIV). In fact, around 90% of people with HIV will experience a rash at some point during the course of their infection. Some rashes are the result of HIV itself, and others are caused by opportunistic infections (OIs) or by the medications taken to treat HIV.

This article will help you learn more about rashes linked to HIV, as well as how they present in regards to symptoms and appearance.

HIV Rash

An HIV rash can occur due to a recent HIV infection, usually appearing within two to six weeks after exposure. Other symptoms that can accompany this rash include flulike symptoms, such as fever, chills, and body aches.

This rash is maculopapular, meaning it’s characterized by both macules and papules. A macule is a flat and discolored area of the skin, while a papule is a small raised bump.

HIV Doctor Discussion Guide

Seborrheic Dermatitis

Seborrheic dermatitis is common in people with HIV, most often occurring in the early stages of HIV, when blood counts of CD4 (white blood cells that are important to fighting infections) are at around 400.

Seborrheic dermatitis is marked by:

• Redness
• Dandruff
• Yellow, greasy scales

Seborrheic dermatitis occurs on areas of the skin where there are lots of sebaceous (oil) glands, such as on 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 a mild case of seborrheic dermatitis are treated with topical ketoconazole 2%, which is an antifungal cream, as well as topical corticosteroids.

Eosinophilic Folliculitis

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.

• Itchiness
• Redness
• Pustules (bumps containing pus)

Eosinophilic folliculitis typically affects the face, scalp, neck, and trunk.

It can be treated with:

• Phototherapy: The use of ultraviolet (UV) light to treat skin conditions
• Moderate-to-high-potency topical steroids: Steroid medications applied directly to the skin
• Emollients: Moisturizing creams and ointments
• Antihistamines: A type of allergy medication used to treat allergic reactions

However, antiretroviral therapy (ART) remains the cornerstone treatment of HIV and gives the best, most-lasting results.

While the cause of eosinophilic folliculitis is unclear, it is linked to fungal infections, bacterial infections, and Demodex folliculorum, a type of mite. It’s thought that EF may be a follicular hypersensitivity reaction or an autoimmune reaction to sebum, or oil.

Papular Pruritic Rash

Papular pruritic rash is quite common in people with HIV, with a reported prevalence of 11%–46%. It is more common in advanced stages of HIV, typically occurring when a person’s CD4 count is under 200.

A papular pruritic rash is marked by itching papules on the arms, legs face, and trunk.

The cause of a papular pruritic rash is not fully understood. However, a hypersensitivity to insect bites and a form of chronic recall reaction to insect antigens due to HIV-associated immune dysregulation may be to blame.

Treatment includes antihistamines and topical corticosteroids.

Other conditions in which papular pruritic rash is common include:

• Hives: This is a skin rash in response to an irritant.
• Transient acantholytic dermatosis: Also known as Grover disease, this is an itchy rash on the trunk of the body.
• Prurigo simplex: This is a chronic, itchy skin condition that causes skin nodules and lesions.

A CD4 count below 200 is classified as AIDS, the most advanced stage of an HIV infection.

Xerotic Ezcema

Xerotic eczema is a common type of HIV rash marked by severe dryness and itchiness. It typically occurs when the CD4 count falls under 200. It is most common and severe during the winter months.

When xerotic eczema develops in an advanced HIV infection, it may be accompanied by acquired ichthyosis and wasting syndrome.

Cytomegalovirus (CMV) Rash

An opportunistic infection (OI) affects people with weakened immune systems, while an AIDS-defining condition indicates that someone has AIDS. CMV is one of 23 AIDS-defining conditions that typically occur when the CD4 count is under 100.

CMV appears as small, elevated, purpuric, reddish papules and macules. CMV may almost manifest as other lesions, such as nonhealing perianal or vulvar ulcers. Diagnostic testing will differentiate a CMV rash from a herpes simplex or varicella zoster (causing chicken pox and herpes zoster) infection.

Chronic CMV infection is treated with Zigran (ganciclovir), an antiviral drug.

Prurigo Nodularis

Prurigo nodularis is a skin condition that causes extremely pruritic 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.

Treatment options include:

• Antihistamines
• Topical corticosteroids
• Phototherapy
• Oraflex (benoxaprofen), a nonsteroidal anti-inflammatory drug (NSAID)
• Steroid injections into the nodules

If someone with HIV develops prurigo nodularis, they should be monitored for the development of neuropathy, which is nerve pain.

Drug Hypersensitivity

Drug hypersensitivity is an adverse immune system reaction to a mediation. In people with HIV, given the many drugs used to manage the infection, these patients are at higher risk of developing drug hypersensitivity.

Mild cases of drug hypersensitivity typically involve a maculopapular rash with a delayed allergic reaction, usually appearing between one to six weeks.

Treating drug hypersensitivity requires a multifaceted approach, given that it is difficult to know which drugs are causing the reaction. Mild cases often don’t require drug discontinuation. However, if the drugs need to be stopped, a patient should be closely monitored.

Drug hypersensitivity is 100 times more common in people with HIV.

Stevens-Johnson Syndrome/Toxic Epidermal Necrosis

Stevens-Johnson syndrome (SJS) and toxic 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%.

SJS and TEN in people with HIV is extremely rare, and is marked by:

• Fever
• Malaise (general feeling of being unwell)
• Upper respiratory tract infection symptoms (cough, rhinitis, sore eyes, and myalgia, muscle pain)
• Blistering rash and erosions on the face, trunk, limbs, and mucosal surfaces

Complications include sepsis and organ failure. Drugs most commonly associated with SJS and TEN in people with HIV include:

• Anticonvulsants
• Beta-lactam antibiotics
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Sulfonamides

Treatment also includes:

• Stopping the drug that causes the SJS or TEN
• Fluid replacement
• Nutritional assessment (may require nasogastric tube feeding)
• Temperature control (warm environment, emergency blanket)
• Pain relief and management
• Supplemental oxygen and, in some cases, intubation with mechanical ventilation

When to See a Doctor

If you suspect that you have SJS or TEN, you should call 911 or see your doctor right away.

Summary

A rash can be a cause and an effect of an HIV infection. If someone suspects they have HIV and develop a rash, they should begin ART as soon as possible to mitigate the effects.

A Word From Verywell

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 an incredibly treatable condition. Talk to your doctor about any concerns you may have.

13 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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8. Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. Evidence and Recommendations on Papular Pruritic Eruption. World Health Organization
9. U.S. Department of Veteran Affairs. AIDS-defining illnesses.
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11. 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
12. 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
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By Molly Burford
Molly Burford is a mental health advocate and wellness book author with almost 10 years of experience in digital media.

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