Severe pruritus can occur either in patients who are well-controlled on antiviral therapy or in HIV-infected patients who are not on therapy. Treatment of pruritus should be guided by the primary morphology of the rash or lack thereof. A multiprong approach to treatment may be helpful as underlying dermatoses can be implicated. Idiopathic pruritus should be a diagnosis of exclusion.
Idiopathic, treatment-resistant pruritus is hypothesized to be secondary to the dysregulation of the immune response, which includes hyperactivation of the humoral response in HIV-infected patients. Eosinophilia and/or high IgE levels are sometimes present.
Related topics: pruritus without rash, xerosis
L29.8 – Other pruritus
420721002 – AIDS-associated disorder
Differential Diagnosis & Pitfalls
- Folliculitis – Lesions are always follicular and often concentrated around the trunk; pustules are often present.
- Eosinophilic folliculitis – Lesions favor the scalp, face, and neck.
- Prurigo nodularis – Thickened hyperpigmented nodules, few in number and sparing areas where patients can't scratch, like the mid-back.
- Atopic dermatitis – Dry, scaly, sometimes fissured patches with weeping may be present in those without eczema history.
- Porphyria cutanea tarda – Itchy, painful blisters that heal with scarring are present in sun-exposed areas.
- Contact dermatitis – Nonspecific, eczematous patches, and potential triggering exposures are identified.
- Psoriasis – May be more pruritic in patients with HIV; can be extensive in total body surface area nearing erythroderma.
- Scabies – Burrows in web spaces, intertriginous areas.
- Polycythemia vera – Laboratory abnormalities and itching that is exacerbated by warmth exposure.
- Pruritus secondary to liver disease (see pruritus without rash)
- Pruritus secondary to renal disease (see pruritus without rash)
- Pruritus secondary to xerosis
- Pruritus secondary to thyroid disease
- Medication-induced pruritus
- Pruritus associated with iron deficiency anemia
- Delusions of parasitosis – Diagnosis of exclusion.