Types of Rash Associated With an HIV Infection

An HIV rash may be identified by characteristics like flat or raised red patches, small raised bumps, red or yellow scales, or blisters. An HIV rash may appear on the face, neck, and upper body, but it can also show up elsewhere. It is usually mildly itchy and may even be painful. A rash can be one of the early signs of a new HIV infection, but it may also be caused by advanced HIV or the drugs used to treat the virus.

HIV is transmitted from person to person when bodily fluids like blood, semen, vaginal fluids, rectal fluids, and breast milk come into contact with each other. You can get HIV during unprotected sex or when you share needles with an infected person.

This article explores four types of rashes commonly seen in people with HIV and what can be done to treat them.

What Is an HIV Rash?

Person with HIV Rash — U.S. National Library of Medicine / National Institutes of Health

This is a type of rash that occurs when the immune system reacts to the presence of HIV. This type of HIV rash usually starts two to six weeks after exposure to the virus. A rash occurs in around half of early HIV cases.

The rash is described as maculopapular, meaning there are flat, reddened patches on the skin (macules) covered with small, raised bumps (papules). In people with darker skin, the rash may be a deep, purple color.

While many diseases can cause this type of rash, an "HIV rash" will generally affect the upper part of the body. There may also be ulcers in the mouth or on the genitals. The rash can be itchy or painful. Flu-like symptoms are also common, such as:

Fever and chills
Muscle aches
Night sweats
Swollen lymph nodes
Sore throat
Feeling very fatigued or unwell

The early symptoms of HIV including the HIV rash will usually go away within one to two weeks. If the rash is severe, the doctor may prescribe an over-the-counter hydrocortisone cream to help relieve the itching and swelling.

When to See a Healthcare Provider

If you think you have been exposed to HIV and you develop a rash either on its own or along with flu-like symptoms, see your healthcare provider right away to get an HIV test.

Once HIV is confirmed with an HIV test, antiretroviral therapy should be started immediately to control the virus and prevent the condition from progressing. HIV causes a compromised immune system, which can put you at increased risk of developing a rash from sources such as viruses, bacteria, or fungi.

Seborrheic Dermatitis

Seborrheic dermatitis is one of the most common causes of an HIV rash. It affects over 80% of people with advanced HIV infection but can even affect those whose immune systems are only moderately impaired.

Seborrheic dermatitis causes inflammation of the scalp, face, torso, and upper back. It most often affects oily parts of the skin, causing redness and yellowish scales. Although the cause is unknown in people with HIV, the condition is not contagious.

In severe cases, seborrheic dermatitis can cause scaly pimples around the face and behind the ears. The nose, eyebrows, chest, upper back, armpits, and inside of the ear may also be affected.

Topical steroids may be used for severe cases. People with HIV who are not yet on antiretroviral therapy should be started immediately to preserve or restore the immune system.

Rashes Caused by Other Infections

Shingles.jpg used under a Creative Commons license at http://commons.wikimedia.org/wiki/File:Herpes_zoster_chest.png — Herpes zoster (shingles). Photograph © Fisle, 2007

HIV weakens your immune system, making you more likely to become infected by other viruses, bacteria, or fungi. People with untreated HIV are more likely to develop rashes from causes such as the following:

Herpes viruses include herpes zoster, which is the virus that causes chicken pox and shingles. You may also be more likely to have frequent outbreaks of oral or genital herpes.
Molluscum contagiosum is a skin infection that causes small bumps to appear on your body. These bumps are usually flesh-colored and may have a dimple in the center.
Viral warts are caused by human papillomavirus (HPV). They may appear anywhere on the body, including the genitals. These are common in people with HIV.
Fungal infections happen when fungus invades the skin, hair, or nails.

Medication-Related Rashes

A person experiencing a drug hypersensitivity reaction — U.S. National Library of Medicine

Antiretroviral drugs and other drugs that treat HIV-related infections can sometimes trigger a rash. The rash tends to appear one to two weeks after the start of treatment. Some have been known to develop within one to two days.

The rash is most commonly morbilliform, meaning measles-like, and made up of flat or slightly raised red, circular, or oval patches. It usually affects the torso before spreading to the arms, legs, and neck.

In some cases, the rash may be maculopapular with tiny bumps that release a small amount of fluid when squeezed. The reaction may be accompanied by fever, fatigue, and swollen lymph nodes.

Ziagen (abacavir) and Viramune (nevirapine) are two antiretroviral drugs commonly linked to drug hypersensitivity reactions.

If you develop a rash after you start a new medication, talk to your healthcare provider. You may need to discontinue the use of the drug.

Antihistamines may be prescribed to reduce redness and swelling. In severe cases, emergency care may be needed if there is trouble breathing, swelling, or other signs of a severe allergic reaction called anaphylaxis.

Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) is a potentially life-threatening drug reaction that causes the top layer of skin to detach from the lower layer.

SJS usually begins with a fever and sore throat one to three weeks after starting treatment. This is soon followed by painful ulcers on the face and chest. Ulcers may also appear on the genitals and inside the mouth.

Round lesions about an inch wide will then start to appear on the face, trunk, limbs, and soles of the feet. The lesions grow together quickly and form blisters that erupt, peel, ooze, and crust over. If left untreated, the massive loss of skin and fluid can cause sepsis, shock, and death.

Viramune (nevirapine) is one HIV drug commonly linked to SJS. Ziagen (abacavir) and sulfa antibiotics can also trigger a reaction.

The drug is stopped once symptoms of SJS appear. Emergency care is essential and may include antibiotics, intravenous (IV) fluids, and treatments to prevent eye damage.

In severe cases, recovery time can sometimes take months. The risk of death from SJS is roughly 10%.

HIV Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

HIV Rash Treatment

Treatment for an HIV rash depends on what's causing it. A rash that develops in the early stages of HIV may be treated with hydrocortisone cream to relieve itching. Antiretroviral treatment can help prevent the development of other types of rashes.

Other types of HIV rash may also require topical treatment with steroid medications. If your rash is caused by a medication, you may need to stop using it. Allergic reactions to medication may also be treated with antihistamines. Severe drug reactions may require emergency measures including antibiotics, IV fluids, or other treatments.

When to See a Healthcare Provider

You should discuss any rash with your healthcare provider. They may be able to provide treatments or recommend a medication change that can help resolve your symptoms.

Call 911 or seek emergency care if you have a rash along with signs and symptoms of anaphylaxis, including:

Shortness of breath
Wheezing
Irregular or rapid heartbeat
Swelling of the face, throat, or tongue
Dizziness or fainting
Nausea or vomiting
Sudden diarrhea
A feeling of impending doom

Summary

When people talk about an HIV rash, they can either mean a rash that occurs during the beginning stage of infection or later on in the condition when the immune system is damaged. It can also be caused by a hypersensitivity reaction to medications used to treat HIV or HIV-related infections.

Depending on the cause, the rash may be managed with steroids, antibiotics, or antihistamines. If the rash is the result of a drug reaction, HIV treatment is almost invariably stopped.

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Altman K, Vanness E, Westergard RP. Cutaneous manifestations of human immunodeficiency virus: a clinical update. Curr Infect Dis Rep. 2015;17(3):464. doi:10.1007/s11908-015-0464-y
Matsumoto S, Murata Y, Tomoda Y. Acute HIV infection in a 39-year-old man. CMAJ. 2022;194(45):E1541. doi:10.1503/cmaj.220656
Cowan EA, McGowen JP, Fine SM, et al. Box 1: acute retroviral syndrome (a). In: Diagnosis and Management of Acute HIV [Internet].
Borda LJ, Wikramanayake TC. Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol. 2015;3(2). doi:10.13188/2373-1044.1000019
Motswaledi HM. Common dermatological conditions in the HIV patient. S Afr Fam Pract. 2019;6(sup1):S19-S24. doi:10.1080/20786190.2019.1610234
Yunihstuti E, Widhani A, Karjadi TH. Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management. Asia Pac Allergy. 2014;4(1):54-67. doi:10.5415/apallergy.2014.4.1.54
Fakoya AOJ, Omenyi P, Anthony P, Anthony F, Etti P, Otohinoyi DA, Olunu E. Stevens - Johnson syndrome and toxic epidermal necrolysis; Extensive review of reports of drug-induced etiologies, and possible therapeutic modalities. Open Access Maced J Med Sci. 2018;6(4):730-738. doi:10.3889/oamjms.2018.148
National Library of Medicine. Stevens-Johnson syndrome/toxic epidermal necrolysis.
du Toit JD, Kotze K, van der Westhuizen HM, Gaunt TL. Nevirapine-induced Stevens-Johnson syndrome in children living with HIV in South Africa. South Afr J HIV Med. 2021;22(1):1182. doi:10.4102/sajhivmed.v22i1.1182
National Library of Medicine. Anaphylaxis.

By James Myhre & Dennis Sifris, MD
Dr. Sifris is an HIV specialist and Medical Director of LifeSense Disease Management. Myhre is a journalist and HIV educator.

See Our Editorial Process

Meet Our Medical Expert Board

Was this page helpful?

Thanks for your feedback!

What is your feedback?

How to Identify an HIV Rash

What Is an HIV Rash?

When to See a Healthcare Provider

Seborrheic Dermatitis

Rashes Caused by Other Infections

Medication-Related Rashes

Stevens-Johnson Syndrome

HIV Doctor Discussion Guide

HIV Rash Treatment

When to See a Healthcare Provider

Summary