Pruritic papular eruptions of HIV: A clinicopathologic and therapeutic study

Lakshmi, S. Jhansi; Rao, G Raghurama; Ramalakshmi,; Satyasree,; Rao, Krishna A; Prasad, P. Rajendra; Kumar, Y Hari Kishan

doi:10.4103/0378-6323.44318

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…[5] PPEs manifest in advanced immunosuppressive stage in majority of the cases, but they may appear as an initial cutaneous disease with high CD4 count. [1] The present case also had CD4 count of 431 cells/mm 3 when diagnosed. Liautaud et al .…”

Section: Discussionsupporting

confidence: 51%

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Pruritic papular eruptions as presenting illness of HIV

Naswa

Khambhati

Marfatia

2011

Indian J Sex Transm Dis

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Mucocutaneous manifestations can be the first markers of HIV. We are reporting the case of an adolescent girl who presented with chronic, recurrent, intensely pruritic papular lichenified eruptions over extremities, face and trunk, which were exudative and crusted at places. She had delayed milestones with growth failure and no pubertal features. She did not have any risk factors to be suspected for HIV. The lesions were refractory to treatment, so she was tested for HIV and she came out to be HIV positive. This case reports pruritic papular eruptions as presenting illness of HIV.

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Section: Discussionsupporting

confidence: 51%

“…[1] The exact etiology of PPE is unknown, but might be an altered and exaggerated immune response to arthropod antigens. [4]…”

Section: Discussionmentioning

confidence: 99%

Pruritic papular eruptions as presenting illness of HIV

Naswa

Khambhati

Marfatia

2011

Indian J Sex Transm Dis

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“…In patients with PPE, average CD4 counts have been reported to range between 46 and 165 cells/µL [3,5–11]. Beginning in 1983, studies from African countries [1,2,12–16], India [8,17], Thailand [18,19], China [20], and Brazil [9] described an extremely pruritic, diffuse skin eruption occurring in HIV-positive patients. The primary lesion for PPE is a firm, discrete, erythematous, urticarial papule or pustule originating on the extremities and occasionally evolving onto the trunk [3].…”

Section: Introductionmentioning

confidence: 99%

Etiology and risk factors associated with a pruritic papular eruption in people living with HIV in India

Farsani¹,

Kore²,

Nadol³

et al. 2013

Journal of the International AIDS Society

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IntroductionPapulopruritic eruption (PPE) occurs in people living with HIV in India. Understanding the risk factors associated with this disease may help decrease the prevalence of PPE.MethodsThis study was a case-control study performed at the Government Hospital of Thoracic Medicine, a tertiary care hospital in Chennai, India. Cases included HIV-positive, antiretroviral (ARV) therapy-naïve adults experiencing a pruritic skin eruption for longer than one month, with evidence of multiple papular or nodular lesions and biopsy consistent with arthropod bite. Controls included HIV-positive, ARV-naïve patients without active skin rash. Main outcome measures were CD4 cell count, histology, and environmental exposures. We performed statistical analysis using Epi Info version 3.5.1 and SPSS version 11.0 (SPSS Inc., Chicago, IL). Categorical variables such as gender, urban versus rural residence, occupation, treatment history, CD4 count, use of insect repellents, and environmental exposures were evaluated using the χ2 test (or the Fisher exact test when an expected value for a category was less than 5). The t-test was used to evaluate differences in age and the duration since HIV diagnosis. The Mann-Whitney test was used to compare non-normally distributed values such as CD4 cell count. A p-value that was less than 0.05 was considered to be statistically significant.ResultsForty-one cases and 149 control subjects were included. Subjects with PPE had significantly lower CD4 cell counts compared to controls (225.5 cells/µL vs. 425 cells/µL; p=0.0001). Sixty-six percent of cases had a CD4 cell count less than 350 cells/µL. PPE cases were less likely to use mosquito repellent techniques (odds ratio 2.81, CI = 1.45–5.45).DiscussionPPE may be an altered and exaggerated immune response to arthropod bites in HIV-positive patients. CD4 cell count is significantly lower in patients with PPE, and therefore it may be considered a qualifying clinical finding for ARV initiation in resource-poor settings. Protective measures against mosquito bites appeared to be important in preventing PPE in subjects at risk.

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“… 9 Initial skin treatment in these circumstances may involve potent topical corticosteroids and high-dose oral antihistamines. 10 , 11 Narrowband ultraviolet B and psoralen and ultraviolet A have been reported to be effective, although the period of remission may be brief. 12 Other systemic treatments reported to be effective in observational studies are dapsone and pentoxyfylline.…”

Section: Discussionmentioning

confidence: 99%

“… 12 Other systemic treatments reported to be effective in observational studies are dapsone and pentoxyfylline. 11 , 13 …”

Section: Discussionmentioning

confidence: 99%