Cutaneous manifestations associated with HIV preexposure prophylaxis: what to expect and when to worry

Preexposure prophylaxis (PrEP) represents a cornerstone in HIV prevention, yet its broader clinical implications are less frequently explored. This review summarises current evidence on dermatological manifestations associated with PrEP use, including drug-induced reactions, sexually transmitted and contact-acquired infections, and cutaneous effects related to recreational substance use and chemsex practices.

Antiretroviral agents approved for PrEP exhibit excellent dermatologic tolerability, with cutaneous adverse drug reactions rarely reported in clinical trials. When present, these typically manifest as mild maculopapular or urticarial rashes, though rare hypersensitivity syndromes have also been described. Doxycycline, increasingly used as postexposure prophylaxis against bacterial sexually transmitted infections, can induce photosensitivity and fixed drug eruptions. In parallel, the expansion of chemsex practices - commonly involving methamphetamine, mephedrone, and cocaine - has introduced a new spectrum of dermatological conditions, including infectious complications, traumatic lesions, vasculitic or necrotic reactions, and severe toxic-allergic responses.

Cutaneous findings in PrEP users often arise from a complex interplay of pharmacologic exposure, infectious risk, and behavioural factors. Recognizing these dermatologic clues during PrEP follow-up offers an opportunity for early diagnosis, appropriate management, and targeted harm-reduction interventions in populations at a high risk for both HIV and other sexually transmitted or contact-transmitted diseases.