For many people newly infected with HIV, a rash is one of the earliest symptoms. A wide range of illnesses, infections, and allergic reactions can irritate the skin, however, so a rash alone is never sufficient to diagnose HIV.
People who develop a rash and believe that they may have been exposed HIV should see the doctor. People are at risk of exposure through sex with someone whose HIV status is unknown, sharing needles, or a blood transfusion, for example.
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What does an HIV rash look like?
A seroconversion rash occurs as the body produces HIV antibodies.
There is no single rash that is specific to people who have HIV. This is because when a person develops HIV, changes in their immune system can trigger a number of skin reactions.
Within a few weeks of HIV infection, many people develop flu-like symptoms and a rash. This process, known as seroconversion, occurs as the body produces HIV antibodies.
Seroconversion illness may also cause a fever and swollen lymph nodes. This HIV rash doesn't itch, and is usually flat and red. It often affects large areas of the body, such as the chest or back.
Reactions to HIV drugs
An allergic reaction to HIV drugs can also cause a skin rash. This type of rash usually presents as a large red area covered in tiny red bumps.
Many people experiencing an allergic reaction may also have a fever and muscle pain.
Rashes due to a weakened immune system
Because HIV reduces the immune system's ability to fight off infections, people with the disease are at risk from a range of skin infections and rashes.
Cellulitis is an infection in the deepest layers of skin that can cause intense swelling and pain. Cellulitis is sometimes accompanied by a fever, and spreads quickly. Cellulitis often begins with a small nick or cut in the skin. The skin is often inflamed and hot to the touch. As the rash spreads, red streaks may extend from the main site of infection. Cellulitis can also occur even if the skin is not damaged by cuts.
Herpes may develop as a rash on the mouth for people with HIV as their bodies may struggle to fight the herpes virus.
Herpes is highly contagious, and manifests as a rash. People with HIV are poorly equipped to fight the herpes virus, so tend to develop worse symptoms than those without HIV.
People with shingles develop painful bumps, usually on just one side of the body. However, people with HIV and other diseases that weaken the immune system may develop shingles on both sides of the body.
Other rashes that can occur include:
- Molluscum contagiosum: This wart-like condition causes lesions that can spread to other people. The lesions are skin-colored and do not hurt, but they tend to get worse over time.
- Folliculitis: This is caused by an infected hair follicle. It's common on shaved areas of the body, such as the legs or the face, and produces red, pus-filled bumps. The bumps can resemble a pimple, and may contain an ingrown hair. Folliculitis can occur as a single bump, or as large groups of painful, itchy bumps.
- Dermatitis: There are many forms of dermatitis, but the most common in people with HIV is seborrheic dermatitis. This itchy rash causes scaly plaques, usually on the face, scalp, chest, or groin. It tends to get worse over time.
- Psoriasis: Psoriasis resembles seborrheic dermatitis, but the patches are scaly and don't usually itch.
- Scabies: Scabies is caused by a mite that burrows into a person's skin. People with scabies experience intense itching and red, raised bumps. The bumps are often surrounded by lines, which show where the mites have burrowed. Scabies is highly contagious.
- Fungal infections: People with HIV can develop a variety of fungal infections. One of the most common is ringworm.
- Other skin infections: Various strains of the bacteria staphylococcus can cause skin infections in people with HIV. One particularly severe infection, methicillin-resistant staphylococcus aureus (MRSA), is resistant to a number of antibiotics.
Symptoms that may accompany an HIV rash
Sometimes a rash is the only symptom. However, because an HIV rash usually signals an issue with the immune system, other symptoms are common. The symptoms that can accompany an HIV rash include:
- flu-like symptoms, such as muscle aches, chills, or a general feeling of illness
- fever, particularly if the rash is due to a skin infection
- swollen lymph nodes
Some people may experience mobility issues. Cellulitis, for example, can cause swelling that makes movement painful.
How do rashes change over time
Rashes such as psoriasis may come and go for people with HIV. The severity of the rash will be based on immune function.
HIV-related rashes vary greatly. The specific outlook depends on the type of rash, as well as individual factors, such as overall health, use of antiretroviral drugs, access to medical care, and exposure to contagious skin conditions.
The rash associated with seroconversion, which occurs shortly after infection, usually disappears on its own.
Rashes due to chronic conditions, such as herpes and psoriasis, tend to come and go. The severity of each outbreak varies, but is partly dependent on immune function. Some medications, such as antiviral drugs for herpes, can reduce the severity of each outbreak.
Rashes caused by infections will go away with proper treatment. However, because HIV steadily weakens the immune system, an infectious rash may return. Cellulitis in particular tends to recur. People with HIV who have had one infectious rash may also later develop a different infectious rash.
When to see a doctor
Prompt HIV testing is an important weapon in the fight against HIV. Early diagnosis enables effective treatment, and can potentially lead to a longer life.
People who develop a rash or flu-like symptoms should see their doctors if they may have been exposed to HIV. Anyone can contract HIV after exposure to infected blood, semen, vaginal fluids, or breast milk.
Some risk factors for HIV infection include:
- a recent blood transfusion
- use of needles to inject drugs, particularly among people who share needles
- high-risk sex, including non-monogamous sex, unprotected sex, including vaginal and anal sex
- sex with a new partner if that partner's HIV status is unknown
- a child breastfeeding from an HIV-positive woman
- breastfeeding a child with HIV
People who are already HIV-positive should see a doctor if a new rash develops or an existing rash gets worse. Because HIV undermines the immune system, allowing infections to more quickly spread, even a minor infection can become life threatening if left untreated.
Rashes that quickly spread, that are accompanied by swollen lymph nodes or a fever, or that produce symptoms, such as exhaustion or vomiting may need emergency medical treatment.