Differential Diagnosis for HIV Positive Patient with Macular Papular Lesion over Face

• Single most likely diagnosis
  • Seborrheic dermatitis: This condition is common in HIV-positive individuals and can present with macular papular lesions on the face, particularly in the nasolabial folds, eyebrows, and scalp. The immune suppression associated with HIV can exacerbate seborrheic dermatitis.
• Other Likely diagnoses
  • Pityriasis rosea: Although not exclusive to HIV-positive patients, pityriasis rosea can be more severe and atypical in immunocompromised individuals, presenting with a macular papular rash that could initially appear on the face.
  • Drug eruption: Given that HIV-positive patients are often on multiple medications, including antiretroviral therapy, drug eruptions are a common consideration. These can manifest as macular papular rashes and can be due to a variety of medications.
  • Syphilis (secondary): Secondary syphilis can present with a macular papular rash on the face among other areas, and HIV-positive individuals are at higher risk for syphilis due to shared risk factors and potentially compromised immune response.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Kaposi's sarcoma: While more commonly associated with nodular lesions, Kaposi's sarcoma can present with macular papular lesions in HIV-positive patients, especially those with advanced immunosuppression. It's crucial to consider this diagnosis due to its potential for aggressive disease and the importance of early intervention.
  • Mycobacterial infections (e.g., Mycobacterium avium complex): Disseminated mycobacterial infections can cause a variety of skin manifestations, including macular papular rashes, in severely immunocompromised HIV-positive patients.
• Rare diagnoses
  • Malignant melanoma or other skin cancers: Although rare, the risk of skin cancers, including malignant melanoma, may be increased in HIV-positive individuals due to chronic immune suppression. Any new or changing skin lesions should be evaluated for malignancy.
  • Bacillary angiomatosis: Caused by Bartonella species, this condition can present with skin lesions that might resemble macular papular rashes, among other symptoms, in immunocompromised patients.