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Almost every HIV-positive person experiences skin problem(s) at some point during their illness. That is because HIV can significantly increase the likelihood of common skin conditions that affect the general population, but it can also cause an HIV-specific, itching rash that is one of the first indicators of infection. [1, 2] Dermatology of the Patient with HIV. Emergency Medicine Clinics of North America.
https://sci-hub.se/10.1016/j.emc.2010.01.001
Skin conditions relating to HIV infection. DermNet.
https://dermnetnz.org/topics/skin-conditions-relating-to-hiv-infection

What is HIV rash?

Skin problems affect about 90% of patients with HIV, and this high prevalence is due to the effect of HIV on a person's immune system. The rash can have different shapes, colors, and severity depending on the causative factor and the stage of the disease. [2, 3] Skin conditions relating to HIV infection. DermNet.
https://dermnetnz.org/topics/skin-conditions-relating-to-hiv-infection
Primary HIV infection. International Journal of STD & AIDS. International Journal of STD & AIDS.
https://sci-hub.se/10.1258/0956462021924613

An HIV-specific rash, which appears in up to 67% of patients during the acute HIV infection (early stage seroconversion rash), occurs a few days to 4 weeks after HIV infection and is characterized with widespread, itching lesions that resolve on its own within few weeks of appearance. [2, 3] Skin conditions relating to HIV infection. DermNet.
https://dermnetnz.org/topics/skin-conditions-relating-to-hiv-infection
Primary HIV infection. International Journal of STD & AIDS. International Journal of STD & AIDS.
https://sci-hub.se/10.1258/0956462021924613

What does HIV rash look like?

The so-called HIV rash, which occurs during the acute phase of infection, is characterized by multiple symmetric, reddish bumps (macular rash), which most often appear on the trunk, face, limbs, soles, and palms. [4] Acute human immunodeficiency virus infection syndrome. DermNet. https://dermnetnz.org/topics/acute-human-immunodeficiency-virus-infection-syndrome

Other HIV symptoms

Around 50-90% of newly infected HIV patients experience early symptoms of HIV. They usually last for 1-3 weeks and include: [3] Primary HIV infection. International Journal of STD & AIDS. International Journal of STD & AIDS. https://sci-hub.se/10.1258/0956462021924613

• Fever and chills

• Sore throat

• Fatigue

• Lymph node enlargement

• Headache

• Muscle pain

• Mouth ulcers

Other common rash types and causes

People with HIV experience various types of rashes, ranging from antiretroviral therapy (ART)-associated drug reactions to infectious conditions and autoimmune diseases. Let’s discuss the causes and rash specificities in more detail: [5] A Comprehensive Review on HIV-Associated Dermatologic Manifestations: From Epidemiology to Clinical Management. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10368516/

• Medication-related rashes: Medications used for HIV management (Antiretroviral therapy (ART)) or prevention of opportunistic infections among HIV patients can potentially cause skin rashes, which, depending on the drug type, can present as itchy, small red bumps, hives, or pigmented nail bands. [6] Cutaneous Manifestations. National HIV Curriculum. https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all

• Papular pruritic eruption (PPE): This condition of unknown cause presents as multiple itchy, symmetric, firm, raised bumps on the trunk, limbs, and face (rarely). [5, 7] A Comprehensive Review on HIV-Associated Dermatologic Manifestations: From Epidemiology to Clinical Management. PubMed Central.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10368516/
Pruritic papular eruption of HIV. DermNet.
https://dermnetnz.org/topics/pruritic-papular-eruption-of-hiv

• Herpes simplex: This rash is caused by herpes simplex virus (HSV) and is described as grouped,fluid-filled blisters on a red base. The rash typically appears around the mouth, genitals, and anal region. In advanced HIV cases, the blisters can turn into deep sores. [1] Dermatology of the Patient with HIV. Emergency Medicine Clinics of North America.
https://sci-hub.se/10.1016/j.emc.2010.01.001

• Herpes zoster: This rash is caused by the varicella-zoster virus and manifests as painful, grouped, fluid-filled blisters on a red base that can merge and form larger blisters. The rash typically occurs on one side of the body. [6] Cutaneous Manifestations. National HIV Curriculum. https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all

• Syphilis: Primary syphilis manifests as a syphilitic chancre, a single, painless, firm, round ulcer with raised borders. HIV patients may also experience an atypical form of the disease, described as multiple, painful, or lacerated chancres. Secondary syphilis rash appears as raised and scaly lesions occurring on the extremities, palms, soles, face, and mucous membranes. Patients with HIV may also experience widespread blistering and peeling. [8] Evaluation of syphilis in patients with HIV infection in Nigeria. Tropical Medicine and International Health. https://sci-hub.se/10.1111/j.1365-3156.2004.01344.x

• Genital and extra-genital warts: These warts are caused by human papillomavirus (HPV) and are flesh-colored, ranging from smooth, flattened lesions to cauliflower-like bumps. Some patients may experience multiple lesions, pain, burning, or itching. [6] Cutaneous Manifestations. National HIV Curriculum. https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all

• Molluscum contagiosum: The rash is caused by the molluscum contagiosum virus (MCV), which appears as small (3-5 mm), discrete,flesh-colored bumps with a central dent. People with advanced HIV may have numerous lesions on the face and genital area. The lesions may lack a central dent and merge into a larger, irregularly shaped bump (giant molluscum). [6] Cutaneous Manifestations. National HIV Curriculum. https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all

• Scabies: The condition is caused by tiny parasites called Sarcoptes scabiei. It is characterized by intense itching and small reddish bumps that can develop into fluid-filled blisters. A distinctive feature is thin, wavy lines on the skin (burrows). Scabies mainly affect areas between fingers, wrists, armpits, feet, genitals, buttocks, and thighs. [6] Cutaneous Manifestations. National HIV Curriculum. https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all

• Thrush: The disease is caused by the fungus Candida albicans and appears as non-adherent whitish plaques on the tongue or throat. [9] HIV-related skin disease in the era of antiretroviral therapy: recognition and management. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581453/

• Seborrheic dermatitis: The disease is caused by the Pitryrosproum ovale (a yeast that also causes dandruff). The rash presents as yellowish greasy scales on a whitish and/or red base. It mostly appears on the scalp, on the face, especially around the nose and eyebrows, and on the upper chest. [1] Dermatology of the Patient with HIV. Emergency Medicine Clinics of North America.
https://sci-hub.se/10.1016/j.emc.2010.01.001

• Psoriasis: This autoimmune disease causes thick, white, scaly patches that can cover almost the entire body. In people with HIV, psoriasis may appear as tiny (1 cm or smaller) lesions on the trunk (guttate psoriasis), plaques in skin folds or areas of skin that rub against each other (inverse psoriasis), or redness and scaling all over the body (erythrodermic psoriasis). [1, 6] Dermatology of the Patient with HIV. Emergency Medicine Clinics of North America.
https://sci-hub.se/10.1016/j.emc.2010.01.001
Cutaneous Manifestations. National HIV Curriculum.
https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all

How severe is HIV rash?

The severity of the rash depends on various factors, such as the cause of the rash, the patient's immune system, and the stage of the disease. In general, patients with advanced HIV infection experience more severe manifestations of various infectious and chronic skin conditions.For example, in HIV/AIDS patients: [6, 10] Cutaneous Manifestations. National HIV Curriculum.
https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all
HIV/AIDS and Skin Conditions. Johns Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/hivaids-and-skin-conditions

• Molluscum contagiosum can cause over 100 bumps

• Scabies may present as scaling plaques resembling psoriasis

• Herpes zoster and herpes simplex infections may result in deep ulcers, scaring, and secondary bacterial infections

Importantly, some rashes may cause deadly complications. As such, AIDS patients have an over 1000-fold higher chance of developing Stevens-Johnson syndrome (SJS). The latter is a life-threatening condition caused by antiviral therapy drugs that occur 2-3 weeks after starting the treatment and appear as red or purple spots that can turn into blisters and peel, resembling severe skin burns. [1, 11] Dermatology of the Patient with HIV. Emergency Medicine Clinics of North America.
https://sci-hub.se/10.1016/j.emc.2010.01.001
Stevens-Johnson Syndrome. Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

HIV rash pictures

Acute HIV rash picture

Early HIV rash: small, red, slightly flat or raisedbumps on the chest.
Early HIV rash: small, red, slightly flat or raisedbumps on the chest.
Early HIV rash: small, red, slightly flat or raisedbumps on the chest.
Early HIV rash: small, red, slightly flat or raisedbumps on the chest.

Papular pruritic eruption (PPE)

Papular pruritic eruption (PPE) in HIV patient presented with multiple, itchy, raised bumps on the chest and upper limbs.
Papular pruritic eruption (PPE) in HIV patient presented with multiple, itchy, raised bumps on the chest and upper limbs.
Papular pruritic eruption (PPE) in HIV patient presented with multiple, itchy, raised bumps on the chest and upper limbs.
Papular pruritic eruption (PPE) in HIV patient presented with multiple, itchy, raised bumps on the chest and upper limbs.

Herpes zoster lesions

Herpes zoster rash in a patient with HIV appears as grouped fluid-filled blisters on a red base.
Herpes zoster rash in a patient with HIV appears as grouped fluid-filled blisters on a red base.
Herpes zoster rash in a patient with HIV appears as grouped fluid-filled blisters on a red base.
Herpes zoster rash in a patient with HIV appears as grouped fluid-filled blisters on a red base.

Molluscum contagiosum lesions

Severe form of Molluscum contagiosum rash on the face of an HIV-positive patient. The rash appears as flesh-colored, raised bump with a central dent
Severe form of Molluscum contagiosum rash on the face of an HIV-positive patient. The rash appears as flesh-colored, raised bump with a central dent
Severe form of Molluscum contagiosum rash on the face of an HIV-positive patient. The rash appears as flesh-colored, raised bump with a central dent
Severe form of Molluscum contagiosum rash on the face of an HIV-positive patient. The rash appears as flesh-colored, raised bump with a central dent

Oral thrush

Oral thrush in an HIV patient that appears as white plaques on the tongue.
Oral thrush in an HIV patient that appears as white plaques on the tongue.
Oral thrush in an HIV patient that appears as white plaques on the tongue.
Oral thrush in an HIV patient that appears as white plaques on the tongue.

Seborrheic dermatitis

Seborrheic dermatitis on the face of an HIV-positive patient, manifested by marked yellowish scales.
Seborrheic dermatitis on the face of an HIV-positive patient, manifested by marked yellowish scales.
Seborrheic dermatitis on the face of an HIV-positive patient, manifested by marked yellowish scales.
Seborrheic dermatitis on the face of an HIV-positive patient, manifested by marked yellowish scales.

Psoriasis

Widespread scaly psoriatic patches and redness in HIV-positive patient
Widespread scaly psoriatic patches and redness in HIV-positive patient
Widespread scaly psoriatic patches and redness in HIV-positive patient
Widespread scaly psoriatic patches and redness in HIV-positive patient

Stevens-Johnson syndrome (SJS) picture

SJS-resulted peeling blisters and redness, resembling severe skin burn.
SJS-resulted peeling blisters and redness, resembling severe skin burn.
SJS-resulted peeling blisters and redness, resembling severe skin burn.
SJS-resulted peeling blisters and redness, resembling severe skin burn.

Rash treatment

An HIV rash can resolve on its own within weeks, but if the rash has resulted from concurrent infection, antiviral medications, increased photosensitivity, or other conditions, it may require specific treatment and lifestyle changes.

Antiretroviral therapy (ART) can significantly improve the immune function of an HIV-infected person, thereby enhancing the body's response to various infectious conditions that cause rash. However, if the rash is caused by the ART itself, it is recommended to discuss changing the drug with your doctor. [12] What does an HIV rash look like? MedicalNewsToday. https://www.medicalnewstoday.com/articles/315963

STDs and other infectious diseases require special treatment (such as antibiotics or antiviral drugs). Over-the-counter medications such as corticosteroid creams or ointments may help with mild rashes. In more severe cases, it is strongly recommended that you contact your healthcare provider. [13] HIV Rash: What Does It Look Like and How Is It Treated?. Healthline. https://www.healthline.com/health/hiv-rash-symptoms-treatments

In general, avoiding exposure to direct sunlight, food allergens, and hot baths can prevent some types of rashes. [13] HIV Rash: What Does It Look Like and How Is It Treated?. Healthline. https://www.healthline.com/health/hiv-rash-symptoms-treatments

FAQ

How long does an HIV rash last?

The rash associated with acute HIV infection goes away on its own within a week on average. [3] Primary HIV infection. International Journal of STD & AIDS. International Journal of STD & AIDS. https://sci-hub.se/10.1258/0956462021924613

How do I know if my rash is related to HIV?

The only definitive way to know whether a rash is related to HIV infection is to see your doctor and get tested, especially if you think you may be infected with HIV.

When to see a doctor

You should see your doctor as soon as possible if you suddenly develop a rash and are at potential risk of contracting HIV (unprotected sex, having multiple partners, injecting drug use, etc.). The sooner you are diagnosed with HIV, the sooner you can begin treatment, which will significantly improve your future well-being and prevent further transmission of the virus.

You should also contact your doctor to consider changing your medication if you have known HIV status and think your rash is due to the medications you take.

Outlook

People with HIV are prone to a variety of skin conditions, some of which can be severe with life-threatening complications. Although lifestyle changes and over-the-counter medications can help relieve rash symptoms, it is essential to seek medical help for diagnosis and effective management.

Source

  1. Dermatology of the Patient with HIV. Emergency Medicine Clinics of North America.
    https://sci-hub.se/10.1016/j.emc.2010.01.001
  2. Skin conditions relating to HIV infection. DermNet.
    https://dermnetnz.org/topics/skin-conditions-relating-to-hiv-infection
  3. Primary HIV infection. International Journal of STD & AIDS. International Journal of STD & AIDS.
    https://sci-hub.se/10.1258/0956462021924613
  4. Acute human immunodeficiency virus infection syndrome. DermNet.
    https://dermnetnz.org/topics/acute-human-immunodeficiency-virus-infection-syndrome
  5. A Comprehensive Review on HIV-Associated Dermatologic Manifestations: From Epidemiology to Clinical Management. PubMed Central.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10368516/
  6. Cutaneous Manifestations. National HIV Curriculum.
    https://www.hiv.uw.edu/go/basic-primary-care/cutaneous-manifestations/core-concept/all
  1. Pruritic papular eruption of HIV. DermNet.
    https://dermnetnz.org/topics/pruritic-papular-eruption-of-hiv
  2. Evaluation of syphilis in patients with HIV infection in Nigeria. Tropical Medicine and International Health.
    https://sci-hub.se/10.1111/j.1365-3156.2004.01344.x
  3. HIV-related skin disease in the era of antiretroviral therapy: recognition and management. PubMed Central.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581453/
  4. HIV/AIDS and Skin Conditions. Johns Hopkins Medicine.
    https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/hivaids-and-skin-conditions
  5. Stevens-Johnson Syndrome. Cleveland Clinic.
    https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome
  6. What does an HIV rash look like? MedicalNewsToday.
    https://www.medicalnewstoday.com/articles/315963
  7. HIV Rash: What Does It Look Like and How Is It Treated?. Healthline.
    https://www.healthline.com/health/hiv-rash-symptoms-treatments
Yeva Margaryan

By Yeva Margaryan, MD

Dr. Yeva Margaryan is a public health specialist specialized in population health promotion and research.

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