Histopathologic study of papular pruritic eruption in people living with HIV-AIDS as seen in Mulago Hospital.

Abstract

Background: Pruritic popular eruption is a generalised pruritic eruption of unclear aetiology. Many PLHA in Uganda suffer from it. This rash appears at all stages of the disease and it has been assumed that there are multiple pathologic entities affecting these patients. Objective: The objective of the study was to establish the histopathology of PPE in PLHA. Methodology: The study was a descriptive cross-sectional study conducted in Mulago hospital. Patients with PPE were selected. Each patient received a detailed explanation of the study in his/her preferred language and provided a written informed consent to a clinical and personal history and skin biopsy. Punch biopsy of skin lesions that had not been traumatised were taken. Histology was done in the Department of Pathology, Faculty of Medicine, Makerere University. Results: The study recruited 134 patients with popular pruritic eruption (PPE) of whom 65.7% were females and 34.3% males. The minimum age was 18 years and the maximum 60 years with Baganda constituting the largest tribe seen. The initial lesions of PPE were on the arms and face but later became generalized. Fifty percent of the patients had a normal epidermis while in the other fifty percent of the patients the epidermis had one lesion or lesions. Several two percent of the patients had a perivascular infiltrate; other lesions found in the dermis included cellular infiltrate of lymphocytes, eosinophils or both, necrobiosis, pigment incontinence severe vessel damage and red cell deposits. The epidermal changes in PPE are attributable to mechanical injury. The dermal changes are suggestive of reaction to insect bites, allergic dermatitis. HIV viral proteins and immune dysregulation may play a role in PPE. In conclusion PPE in HIV shows a varied histological picture with the distribution of the rash anad histologic findings characteristic of reaction to insect bites.