A Scoping Review of Pruritic Papular Eruption in People Living With HIV

Pruritic papular eruption (PPE) is a chronic, intensely itchy skin condition commonly seen in people living with HIV (PLH). While PPE is well documented in regions with high HIV prevalence, its clinical presentation, risk factors, and treatment strategies in the United States remain poorly characterized. Thus, this study aims to fill critical gaps in understanding PPE among PLH in the United States by investigating its epidemiology, clinical features, and risk factors. A comprehensive literature search across PubMed, Google Scholar, and Cochrane identified 8 papers documenting 11 patients with PPE. Our results showed that the most commonly affected areas included the arms (82%), chest (45%), back (45%), face (36%), neck (36%), and anal cleft (18%). Seven patients (64%) had a concurrent bacterial or fungal infection with Candida albicans (42.9%) and Treponema pallidum (42.9%). Candida lesions were most commonly seen in the oral mucosa and inguinal or anal clefts. Overgrowth of commensal organisms such as Demodex folliculorum was also noted in or around the pilosebaceous units for 28.6% of patients. The most common treatment strategies include antiretroviral therapy and adjuvant corticosteroid or ultraviolet B phototherapy which helped relieve the pruritis associated with papulonodular lesions. These findings highlight how PPE may serve as a marker for severe immunosuppression among PLH. In HIV patients who present with a rapid onset of pruritic lesions, PPE should be a key consideration in the differential diagnosis. In these patients, thorough physical examination and further diagnostic evaluation for potentially associated infections is warranted.