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Papular Pritic Eruption Essay

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Introduction:

Papular pruritic eruption (PPE) is the most common cutaneous manifestation of HIV, and is recognized as a WHO Clinical Stage 2 disease of HIV. PPE has a reported prevalence of 11-46% depending on geographic region, and is most commonly reported in African countries, Haiti, Brazil, and Thailand, and is less common in European and North American countries. PPE is characterized by multiple discrete skin-colored or erythematous urticarial papules symmetrically distributed on the body. The lesions are most commonly located on the extremities but can also be found on the trunk, face, or are generalized with sparing of mucous membranes, palms and soles, and digital web spaces. Pruritus begins with lesion appearance, and itching …show more content…

PPE may also be related to HIV infection of the skin and immune dysregulation in the skin. Some studies have suggested that the lesions of PPE are an immunologic manifestation related to the inversion of the normal ratio of CD4:CD8 T cells and the normal ratio of Th1:Th2 response and cytokine profile that occurs in HIV infection and results in the inability to recognize endogenous proteins.

Findings:

PPE is characterized by multiple sharply demarcated urticarial papules that are either skin-colored or erythematous. The lesions are symmetrically distributed and more commonly seen on the extremities, but are also found on the trunk, face, or be generalized with sparing of mucous membranes, palms and soles, and digital web spaces. Studies have shown that 95% of lesions are located on the extremities, arms and legs, most frequently on the extensor surfaces and dorsum of the hands. PPE has a chronic course that waxes and wanes, and the lesions change appearance over time, with new lesions appearing daily. As the pruritus beings with lesion appearance, scratching leads to excoriations, secondary infections, and post-inflammatory hyperpigmentation, eventually leading to scarring and prurigo-like nodules. The lesions of PPE are predominantly papular, but there have been variants reported that display pustular lesions with acneform appearance.

Diagnostic pearls:

• PPE is more common in developing countries in individuals with history of insect bites and NO history of

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