One of the most common symptoms of HIV is a skin rash. These rashes can be an early sign of the condition, or they can appear later.
Modern HIV medications, known as antiretroviral therapy (ART), can effectively reduce the amount of HIV in your blood until it’s undetectable. An undetectable viral load means you can’t transmit the virus to other people.
While not all rashes indicate HIV, it’s important to understand the symptoms, characteristics, and causes of an HIV rash to help you better manage it.
What are HIV rashes?
HIV rashes are irritated areas of the skin that arise because of the viral infection. HIV rashes are also known as:
- acute retroviral syndrome
- seroconversion rash
HIV rashes typically appear within 2–4 weeks after infection with HIV. They can appear anywhere on the body but typically affect the trunk, including the chest, back, and stomach. The rashes may also spread to the face, arms, and legs.
HIV rashes can occur at any stage of the disease and are caused by the virus attacking the immune system, which can be a sign of an acute HIV infection or advanced disease.
The HIV rash can also occur as a reaction to certain medications used to treat HIV, or due to co-infections with other viruses or bacteria.
HIV rashes can vary in appearance depending on the individual and the stage of the virus, but some symptoms include:
- red or purple areas of skin
- itchy or painful areas of skin
- flat or raised lesions
- blisters or sores
- scaling or flaking skin
Flu-like symptoms may accompany the rash. These include:
- fever
- headaches
- muscle aches
- fatigue (low energy)
- sore throat
- swollen lymph nodes
While a rash may be a symptom of HIV, not every person living with HIV will develop a skin rash. So, if you are experiencing any of the symptoms associated with HIV or a skin rash, consider talking with a healthcare professional for a proper diagnosis and treatment.
How to identify an HIV rash
Identifying an HIV rash can be difficult. This is because the symptoms can be similar to other types of skin rashes.
Here are some general characteristics of an HIV rash that can help identify it:
- Appearance: An HIV rash often appears flat or raised. It is red on light-toned skin and purplish on dark-toned skin patches, sometimes with small bumps or blisters.
- Itching or pain: An HIV rash is typically not itchy or painful, but some people may experience discomfort or burning.
- Timing: The rash may appear during the early or acute stage of HIV, which occurs 2–4 weeks after infection. But it can also appear later, such as during the symptomatic stage of HIV transmission.
An HIV rash can also resemble other types of rashes caused by different factors, such as drug reactions, allergic reactions, or infections. So, a proper diagnosis from a healthcare professional is necessary.
Types of HIV rash
Several types of rashes can be associated with HIV, each with its unique appearance and characteristics. Here are some common types of HIV rashes:
- Maculopapular rash: This is among the most common types of HIV rashes. A maculopapular rash appears as flat, red, or purple skin spots, often together with small, raised bumps. It’s usually not itchy or painful.
- Erythema nodosum: This rash presents as painful, tender, and reddened nodules or bumps that typically appear on the shins, ankles, or thighs. The nodules are usually round or oval, ranging in size from a pea to a golf ball. They may appear alongside fever, joint pain, and fatigue.
- Seborrheic dermatitis: This type of rash is also common in people living with HIV. It appears as red, scaly patches on the scalp, face, and other body areas. It is often itchy and can be difficult to treat.
- Stevens-Johnson syndrome (SJS): This is a rare, but serious rash. An adverse reaction to medications used to treat HIV, like nevirapine, can cause it. It typically begins with flu-like symptoms and a red or purple rash that spreads rapidly and can cause blisters and skin peeling.
- Psoriasis: People with HIV may be at higher risk of developing psoriasis, a chronic skin condition characterized by red, scaly patches on the skin. The rash may appear on the scalp, elbows, knees, and other areas.
- Herpes simplex virus (HSV): People with HIV are more likely to develop HSV, a viral infection that causes painful, fluid-filled blisters on the skin. Blisters can occur anywhere but are most common around the mouth, genitals, and anus.
- Hypersensitivity to HIV medications: HIV medication can sometimes cause a skin rash as a side effect. The rash may appear as red or purple blotches or small raised bumps. It can be itchy, painful, or tender to the touch. The rash may appear on any body part but most commonly shows up on the torso, arms, and legs. Some HIV medications are more likely to cause a rash, such as nevirapine ER and etravirine.
Treatments
The treatment for an HIV rash depends on the severity and underlying cause. In some cases, the rash may resolve on its own, while in other cases, medical treatment may be necessary.
Here are some of the treatment options for an HIV rash:
- Antiretroviral therapy (ART): ART is a combination of medications used to treat HIV and reduce the viral load in the body. In some cases, ART can help reduce or eliminate an HIV rash. Common types of ART include Biktarvy, or a combination of Descovy and Tivicay.
- Topical treatments: Topical treatments such as corticosteroid creams or ointments may reduce inflammation and relieve itching associated with an HIV rash.
- Oral medications: In more severe cases, healthcare professionals may prescribe antihistamines or antibiotics to help manage symptoms and prevent infection.
- Avoiding triggers: If an allergic reaction to medication or environmental factors is causing the HIV rash, avoiding the trigger may be necessary to prevent future outbreaks.
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