Eosinophilic folliculitis (EF) is a common intensely pruritic condition often occurring in advanced disease or the situation of IRIS, commonly 3 to 6 months post commencement of ART.[156] There is significant associated morbidity and disfigurement.[157] The role of usually non-pathogenic commensals of the skin including Malassezia yeasts , Demodex mites, Corynebacterium and Staphylococcus is debated.[158] Clinicians should be aware that patients who are about to initiate ART, regardless of regimen, may develop EF during the first 3- to 6-month period after commencing therapy.[159] Pruritic papular eruption (PPE) or HIV prurigo is an incompletely understood entity in HIV with symmetrical papular eruptions on the trunk and limbs in the absence of other definable causes of itching.[160]
Although some believe that eosinophilic folliculitis and pruritic papular eruption are part of the same disease spectrum, the distribution of both diseases are different.[161] PPE occurs more in acral areas and photoexposed areas, and hypersensitivity to arthropod bites or a form of chronic recall reaction to arthropod antigens in the setting of HIV-associated immune dysregulation has been suggested.[162]