Unfortunately, PPE-HIV often responds poorly to conventional antipruritic treatment. One study documented superiority of oral antihistamines over topical steroids in relieving itching. [ 9 ] Ultraviolet B (UVB) light therapy, given three times weekly, has also been shown to reduce itching and improve cosmetic appearance. [ 10 ] Although concerns have arisen regarding UVB radiation potentially activating HIV gene expression, significant changes in HIV RNA levels, CD4 lymphocyte count, or opportunistic infections have not been seen in patients receiving UVB light therapy. [ 11 ] . Pentoxifylline, dosed at 400 mg three times daily, improved pruritus in an 8-week trial of patients with PPE-HIV, but this medication is not available in many resource-limited areas. [ 12 ] Due to the possible association of PPE-HIV with an exaggerated response to arthropod bites, bed nets and insecticides may play an important role in prevention. In addition, initiation of potent antiretroviral therapy has been shown to dramatically decrease the severity of PPE-HIV, often with lesions disappearing and not returnin. [ 13 ]
We recommend initiating therapy with potent antiretroviral therapy, and using both mid- to high potency topical steroids with oral antihistamines to relieve itching in the interim period before PPE-HIV improves from antiretroviral therapy. If PPE-HIV fails to improve after initiation of antiretroviral therapy, then virologic failure should be considered. Where available, metered dosing of UV-B phototherapy can be used if symptomatic relief is not achieved with the measures suggested above. Published studies using ambient UV light for treatment of PPE are lacking, but in many resource-limited areas, this approach is widely used. Care should be taken to avoid burning the skin or inciting a photosensitive eruption, especially when patients are also using potentially photosensitizing medications, such as cotrimoxazole.
2 years and older:
Cream/ointment: Apply a thin layer to the affected area once a day
12 years and older:
Lotion: Apply a thin layer to the affected area once a day
-Safety and efficacy in pediatric patients for more than 3 weeks of use have not been established.
-This topical drug should not be applied in the diaper area if the child still requires diapers or plastic pants.
-Therapy should be discontinued when control is obtained.
-If no improvement is seen within 2 weeks, reassessment of diagnosis may be needed.
Use: Relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses