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Bites that itch and wont heal
Aug 16, 2004

My partner has been HIV positive for 8-10 years and it not yet on any HIV medication (counts are still above 400). He has recently developed an exaggerated reaction to apparent bites (mosquito or other unknown bites). They were accompanied with a reddened rash, swelling, and with other reactions such as small red bumps, spread about "palm" size here and there on his body. Some of the "bites" are near his joints (elbow, knee, ankle). Some are not healing.

A few developed worse symptoms: some *major* swelling around the bites near joints. Some of these have spontaneously ruptured clear fluid. The resulting wound looks more like a blister than a bite. He says there is intense itching and not so much pain.

When smaller versions of the 'bites" began to show up in his scalp, he finally called the Doc.

His doctor tested for every possible infection from scabies to...whatever...and could not diagnose it. He prescribed sulfamethazone and trimethoprim (Bactrim?); also a topical cream called Elocon (Mometasone furoate cream). Many of the small bites began to heal halfway through the antibiotics.

Now post-Bactrim, some bites remain and they seem to take turns producing big swollen areas, first on one ankle, then near a wrist or an elbow. It's maddening.

He also complains of "nerve pain" (not "joint pain") and awful itching.

These reactions to bites, if they are bites at all, must be related to HIV or a compromised immune system - but not to HIV meds, as he is not on them.

He will find an HIV-aware dermatologist next week and see what they can do. Meanwhile, do you folks know what the heck this is? Also, any suggestions for more effective meds? Lastly, might this indicate that he is getting close to needing to do meds?

Response from Dr. Conway

This is, ironically, the effect of an unregulated and over-active immune system rather than any deficiency. The initial reaction is immune-driven, but some of the more significant lesions can becoem infected over time, due to their size, where they are, the fact he is scratching, etc...

The best thing to do might be to go on a non-sedating anti-histamine for the msoquito season. If bites still occur, but some topical anithistamine on them to help tehm heal. if they still get big, a combinaion of a one or more of a local steroid, a short course of prednisone pills (and I emphasize, SHORT), local antibiotics and, if needed, a SHORT course of anitbitic pills may be needed. You can talk about this overall strategy when you meet with the dermatologist.



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