[Question #5784] Pruritic Papular Eruption 3 year old

18 months ago

Hi Dr's,I was here about 2 weeks ago. I had a few tests done after exposures but both tests had some concerning things that made me question them....one being that I fear they were left over the weekend for the lab test and therefore somehow less sensitive and then the rapid test the nurse wiped my finger with an antiseptic wipe after puncturing it, and then collected blood. So I fear the alcohol present could have killed or hid the antibodies.

 

I was told that neither situation was plausible and to trust my results, including even an ora quick one year later.

 

However, my 3 year old girl has broken out in what looks like a prevalent HIV skin manifestation...a pruritic papular eruption? It comes and goes...the lesions may be on her thighs for a few days and gone and then they appear on her arms etc. My wife took her to the pediatrician a few weeks ago and he said they were just bug bites. nobody else in the family are getting bites nearly close to this rate, and she's really not outside much.The papules look kind of like big pimples...3 on one thigh, 2 on the other...and a few appearing on her arm right now. 

 

They do NOT itch, but otherwise looklike this very common HIV rash. I google common kids rashes or bug bites and they really don't look like anything that comes up...but they do look like the papular eruption from HIV. My Questions: 

1. Would PPE always itch? My biggest saving grace is that the papules don't seem to bother her at all

2. How long do the papules/lesions from PPE last? Hers last like 3-7 days each until they go away and others appear elsewhere. 

3. They seem to be most prevalent on her thighs, butt, and arms. I haven't noticed them on her face or neck or hands/feet. Is this consistent with PPE?

Telling my wife about my missteps during a bad time in our marriage would ruin our marriage and have a horrible impact on my children. I obviously don't want to do that, but I also cannot afford to miss anything that might diagnose my poor girl.

 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome back, but sorry you found it necessary. Much of this repeats the questions you had in your recent thread and there ish't much to add to Dr. Hook's replies -- with which I agree. It is not possible you have HIV from the exposure described, and if you happen to have it anyway (from some different exposure), you could not have infedcted your child, assuming no sexual abuse. Household contacts of people with HIV, including young childrten, never catch the virus even after years of sharing toilets, kitchens, eating utensil, and so on -- and regardless or normal parental contact (dressing, hugging, snuggling, kissing, etc).

And you cannot look at an HIV rash and conclude that a similar looking one might be HIV. The HIV rash is identical to the rash caused by many other health problems, especially common childhood infections. I would guess that among all children with rashes like your child's, under one in a million has HIV.  And anyway, the HIV rash generally is not pruritic (itchy), and doesn't appear pimple-like. Your doctor's diagnosis of insect bites probably is correct.

1-3.  PPE is not a standard medical abbreviation but I assume you are referring to the term used in the title of your question. The typical rash of new HIV infections is not at all like you describe in your child, with only a few red bumps that itch. And you already have a reassuring alternate diagnosis from her doctor. And as stated repeatedly, you were not at risk and could not have given HIV to your child.

Please no more questions that repeat what has already been advised.

HHH, MD
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18 months ago
Thanks dr. I’m not referring to the acute hiv rash but the pruritic papular eruptions than all these medical resources say is very common in people with hiv, especially children. 


I was honestly hoping and assuming you had experience dealing with this considering how prevalent it is, even though I’m sure you only deal with adults. My other daughter is 5 and has athletes foot, which is also exceedingly uncommon in children their age. I just don’t know what to do. 

The main thing is she doesn’t seem to be bothered at all. Most publications say that these are extremely itchy. Would you concur? 

Aside from my risk I did have negative tests if you read. Do you agree that if my blood sat out at room temperature over an entire weekend the test would still be reliable? 

18 months ago
Important to note again I believe you misread. No worries of course, but these bumps do not itch. I’m referring specifically to the link I provided, maybe I’m phrasing it wrong but I’m referring to an early-ish hiv manifestation...not the acute rash. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
You're making a basic error in logic. Your username suggests you have some familiarity with data, actuarial analysis, etc. I'll remind you what you may know intellectually but are not integrating into your own situation. If condition A is twice as common in people with a rare condition (like HIV in children in the US) as in the general population, it remains true that the vast majority of people with condition A do not have that rare condition. It's like saying headache is almost always present in people with meningitis, my kid has a headache, so she must have meningitis, even though she lacks any other signs of meningitis, is not at apparent risk, and there's another obvious explanation (she banged her head when she fell from her skateboard, i.e. equivalent to the doctor's diagnosis of bug bites).

As for the rash, in adults (in my experience), itching rash (pruritic) is rare. The link you provicde is interesting and perhaps I'll learn from it. In any case, even the most typical rashes for new HIV infection almost never are caued by HIV, except in people at obvious risk. Which your daughter is not. There is simply no chance you caught HIV or infected your daughter. Also, skin rash is never, ever the only symptom in people with acute HIV. There always is a complex of multiple symptoms, none of which your daughter apparently has.

The HIV blood tests are extremely robust. They remain accurate even when (mistakenly) left at room temperature in tropical Africa for a week or more. Your test results PROVE you do not have HIV.

Dr. Hook and I have been doing our best to reassure you with reasoned, science-based analysis. I urge you to accept it, and stop searching the web for reasons you and your family might the exception to common sense and science. In any case, this isn't a debate and I'm not going to play that game!
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18 months ago
Thanks Doc, but again I’m not sure you are understanding what my fear is. I am NOT concerned about my daughter having the ARS rash. My last exposure was over a year ago, and the other one 18 months. 

I’m concerned about her getting infected somehow shortly after I was...and her now having established HIV. And this pruitic papular eruption I’m reading about is very common in children and adults with established hiv, and early on in that established HIV. I am not at all concerned about her going through ARS. 

And, if you look up this pruitic papular eruption it says that it is almost always itchy and I was curious if you agreed with that. But maybe you haven’t had experience treating that? That’s kind of what I’ve been getting at here. Not worried about ARS. 

If not this papular eruption, do you know of any symptoms to look out for with children/toddlers and hiv? I don’t think she’d be exposed to anything from me besides one time her getting some of my bloody nose on her hands (and I’m not sure if she sucked her thumb or put her hands in her eyes or anything). 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
I did misunderstand the timing. But still, you are ignoring or forgetting that HIV is never trransmitted in households, absent sexual abuse and other obvious risks, and that skin conditions alone would never be the only manifstation of advanced (or early) HIV infection. And your test results prove you don't have HIV, for goodness' sake!

This has turned into a very irrational conversation -- and I don't think on my end. If you can't get over this obvious obsession, your only choice is to speak confidentially with your child's pediatrician and have her tested for HIV. Or stop worrying about the confidentiality:  no matter how much risk to your marriage, if you're truly concerned your child may have HIV, you have an absolute moral obligation to make that not only your primary priority, but your only one. Regardless of consequences, you must arrange for her to be tested.

Be clear:  I am not telling you to do that, and not hinting that I believe there is any chance she has HIV. But if YOU believe it, you MUST act on it, and you must do so immeidately, regardless of the consequences outside your daughter's health. From an ethical standpoint and your responsibility as a parent, you have no choice.

It's up to you. This forum cannot help futher. This will have to be your last question on this topic. Future new questions about these issues will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

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