Physical examination and investigation

History taking is essential (Table 2).  Note the distribution, type of rash and any other associated physical findings including: mucosal changes, hair and nail changes as well as musculoskeletal involvement, lymphadenopathy and organomegaly. If the patient is febrile, urine analysis, chest X-ray and blood cultures should be considered.

Table 2          History essentials in the setting of cutaneous presentations

HIV status

Current and nadir CD4 cell count, and viral load assays


Medical and surgical history


Current and recent medical therapy, including complementary therapy and over-the-counter medications


ŸWith children and adults experiencing similar symptoms

ŸSexual contacts

ŸWith pets, animals, insects, wildlife


Associated exposure


Recent and past

Swabs should be considered for pustular and vesicular lesions. Punch biopsy may also be useful for histopathology. Appropriate cultures or polymerase chain reaction (PCR) studies may need to be performed to detect opportunistic infections such as bacterial, atypical mycobacterial, viral or fungal infections. Imaging may be helpful in evaluating extracutaneous involvement if it is suspected.