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Dermatology · HIV: pruritic papular eruption
Sample itemA man with advanced HIV (CD4 count 90 per microlitre) has intensely itchy, symmetrical, discrete skin-coloured and excoriated papules on the extremities and trunk, with negative scabies tests. What is the best management?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Start antiretroviral therapy with antihistamines and topical steroids
Pruritic papular eruption of HIV is a common, intensely itchy condition in patients with low CD4 counts, and its cause is unclear but may relate to insect bite hypersensitivity. Immune restoration with ART is the key treatment, with antihistamines and topical steroids for symptoms. Other causes such as scabies should be excluded.
Option by option
A. Treat as scabies with repeated permethrin
Scabies is excluded by the negative tests.
B. Start oral isotretinoin
Isotretinoin has no role.
C. Start antiretroviral therapy with antihistamines and topical steroids (correct)
Correct. ART plus symptomatic therapy is the core approach.
D. Give intravenous acyclovir
Acyclovir does not treat this eruption.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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