World Health Organization: “Scabies.”
HIV and AIDS Rashes and Skin Conditions
Skin changes could be the first sign that you have HIV. About 90% of people with HIV get a rash or other skin condition at some point. The virus weakens the immune system and makes it easier for germs that cause skin problems to get in. Some HIV treatments can cause rashes. But thanks to new medicines, when this happens, you can replace the medicine that caused it with another.
Syphilis Rash
2/15
Syphilis spreads through unprotected sex with an infected person. It first shows up as a small, painless sore called a chancre on your genitals, rectum, or mouth. If it’s inside your body, you may not notice it. As it worsens, you can get a rash all over your body, even your palms and the soles of your feet. It doesn’t itch. If you don’t treat syphilis, it can damage your heart, brain, and nervous system. You can also spread it to others.
Molluscum Contagiosum
3/15
These itchy bumps pop up in areas like the face, lower belly, upper thighs, and genitals. You’re more likely to get them with a weakened immune system. Molluscum contagiosum isn’t dangerous, but the bumps can get infected if you scratch them. They can also be unsightly — more than 100 bumps can sometimes form at once. Your doctor can use an ointment, a laser, or freeze the bumps off with liquid nitrogen to rid you of the rash.
Kaposi Sarcoma
4/15
This rare cancer grows in cells that line lymph and blood vessels, forming red or purple patches called lesions. They’re usually in the mouth, nose, and throat but can show up almost anywhere. The patches are a sign that HIV has become AIDS. Today, fewer people with HIV get Kaposi sarcoma thanks to antiretroviral drugs. If you do get it, the main treatments are medicine to put on your skin, cryotherapy to freeze the cells off, or surgery.
Seborrheic Dermatitis
5/15
An itchy scalp that sheds flaky yellow or white scales is a sign of this common skin condition. You may also notice redness and flakes on areas like your face and upper chest. Doctors don’t know exactly what causes seborrheic dermatitis. But if your immune system is weak, you’re more likely to have it. An antifungal cream or medicated shampoo can ease mild symptoms. Steroid cream helps ease swelling and redness when you have a flare.
Eosinophilic Folliculitis
6/15
Follicles are the tiny sacs that hairs grow from. When bacteria or other germs get inside them, this can make them swell and itch. Sometimes the pimple-like bumps itch or fill with pus. Eosinophilic folliculitis is the type that affects people with HIV and AIDS. It causes bumps on the face and upper body. The treatment depends on the type of germ. Antifungal creams or pills treat yeast infections. Antibiotics treat bacteria.
Shingles (Herpes Zoster)
7/15
If you had chickenpox as a kid, you can get shingles as an adult. The varicella zoster virus that causes chickenpox hides in your body. When your immune system is weak, the virus can “wake up” as a painful, blistery rash on one side of your body. Antiviral meds shorten the illness and make it less serious. But a new vaccine can cut the odds that you’ll get this rash in the first place. Doctors suggest it for HIV-infected people over 50.
Herpes Simplex
8/15
Painful sores on the mouth and genitals are the main signs of this other type of herpes infection. It spreads through kissing and sex. Anyone can get herpes simplex, but people with HIV have worse outbreaks and get more of them. Herpes isn’t curable, but antiviral medicines can cut down on the number of outbreaks you get. If you have herpes, use condoms so you don’t spread the virus to your partner.
Prurigo Nodularis
9/15
This skin disease forms hard and intensely itchy lumps on places like your neck, shoulders, arms, and legs. It’s more common in people with skin conditions like eczema. But it can also be a sign that your immune system is weak from HIV or AIDS. Steroid creams or pills are the main treatments. To stop the itch, moisturize your skin every day. And don’t scratch — it will make the lumps worse.
Oral Thrush
10/15
The candida fungus is normally present inside our mouths. If you’re healthy, it doesn’t cause problems. But when you have HIV or AIDS, it can grow too quickly. Then it can form white patches on your tongue, cheeks, and the roof of your mouth that can hurt. If the sores spread down your food tube (esophagus), they can make it hard to swallow. An antifungal drug along with good oral hygiene can clear up a thrush infection.
Genital Warts
11/15
Human papillomavirus (HPV) causes these small bumps on the penis, vagina, and anus. When you have HIV, your body can’t fight off HPV. Your warts may also be harder to treat. Your doctor can freeze or burn them off, or apply a wart-removing cream. The warts are harmless, but the virus that causes them can raise your risk for cervical or anal cancer. If you get the HPV shot, it can stop you from catching the virus in the first place.
Skin Cancer
12/15
A healthy immune system fights off cancer. But when it’s weak from HIV or AIDS, basal cell and squamous cell skin cancers are more likely to grow. These cancers look like pearly or red bumps, or a flat sore that scabs over and then heals. You’ll see them on sun-exposed areas like your face, ears, neck, and hands. If you find a new spot on your skin, or if one changes shape or size, see a dermatologist, who can freeze or cut it off.
Scabies
13/15
This itchy, pimple-like rash appears when mites get into your skin and lay eggs. It spreads easily through skin-to-skin contact with an infected person. People with HIV or AIDS get a type called crusted scabies — when thick crusts form on the skin. You can catch this kind if you share personal items like towels with someone who’s infested. Scabicide medicines kill scabies mites and eggs. Your partner and family should also get treated.
Photodermatitis
14/15
HIV can make your skin more sensitive to the sun’s UV radiation. After you go outside, your skin can turn a sunburn-like red in exposed areas like your face, ears, scalp, neck, and chest. Some of the medicines you take to treat HIV can also make you more sun-sensitive. Stay out of the sun to avoid this rash. When you do have to go outside, put on a high-SPF sunscreen that protects against both UVA and UVB rays.
Oral Hairy Leukoplakia
15/15
White, hairy patches on your tongue or mouth are signs of oral hairy leukoplakia. If you have a weak immune system from HIV, you’re more likely to get the Epstein-Barr virus (EBV) that causes it. It could be a sign that your disease has gotten worse. You need to make sure you’re on HIV treatment and that it’s working. If the patches are very bad, your doctor might give you another antiviral drug or take them off with surgery.
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American Cancer Society: “Basal and Squamous Cell Skin Cancer Risk Factors,” “Local Therapy for Kaposi Sarcoma,” “What is Kaposi Sarcoma?”
BMC Infectious Diseases: “Incidence and risk factors of herpes zoster among HIV-positive patients in the German competence network for HIV/AIDS (KompNet): a cohort study.”
CDC: “Genital HPV Infection — Fact Sheet,” “Scabies,” “Scabies Frequently Asked Questions,” “Shingles Signs & Symptoms,” “Treating Shingles,” “Vaccination,” “Syphilis — CDC Fact Sheet.”
Cleveland Clinic: “Syphilis.”
Cleveland Clinic Journal of Medicine: “Disseminated molluscum contagiosum lesions in an HIV patient.”
Genetic and Rare Diseases Information Center: “Prurigo nodularis.”
Johns Hopkins Medicine: “HIV/AIDS and Skin Conditions,” “Oral Hairy Leukoplakia.”
Mayo Clinic: “Folliculitis,” “Molluscum contagiosum,” “Oral Thrush,” “Scabies,” “Seborrheic dermatitis,” “Skin cancer.”
National Eczema Association: “Seborrheic Dermatitis.”
New Zealand AIDS Foundation: “Human Papillomavirus (HPV).”
NIH AIDS Info: “Kaposi sarcoma (KS),” “Seborrheic Dermatitis.”
SexInfo, UCSB: “Folliculitis.”
Southern African Journal of HIV Medicine: “Photosensitive disorders in HIV.”
Stanford Healthcare: “HIV/AIDS and Skin Conditions.”
StatPearls: “Prurigo Nodularis.”
UC San Diego Health: “HIV-Related Skin and Complexion Conditions.”
U.S. Department of Veterans Affairs: “Herpes simplex virus.”
World Health Organization: “Scabies.”
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 and 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
U.S. National Library of Medicine / National Institutes of Health
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
doble-d / Getty Images.
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
This photo contains content that some people may find graphic or disturbing.
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
This photo contains content that some people may find graphic or disturbing.
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.
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
This photo contains content that some people may find graphic or disturbing.
U.S. National Library of Medicine / National Institutes of Health
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.
- UC San Diego Health. HIV-related skin and complexion conditions.
- Chu C, Selwyn PA. Diagnosis and initial management of acute HIV infection. Am Fam Physician. 2010;81(10):1239-44.
- Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. Evidence and Recommendations on Seborrhoeic Dermatitis. World Health Organization
- 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
- National Center for Advancing Translational Sciences. Eosinophilic pustular folliculitis.
- Simpson-Dent S, Fearfield LA, Staughton RC. HIV associated eosinophilic folliculitis–differential diagnosis and management. Sex Transm Infect. 1999;75(5):291-293. doi:10.1136/sti.75.5.291
- Bellavista S, D’ Antuono A, Infusino SD, Trimarco R, Patrizi A. Pruritic papular eruption in HIV: a case successfully treated with NB-UVB. Dermatol Ther. 2013;26(2):173-175. doi:10.1111/j.1529-8019.2013.01545.x
- Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. Evidence and Recommendations on Papular Pruritic Eruption. World Health Organization
- U.S. Department of Veteran Affairs. AIDS-defining illnesses.
- 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
- 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
- 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
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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