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Atripla Rash
Aug 27, 2010

I know that there's some stuff about this in the archives but I have a couple of questions I couldn't quite find.

On the 8th day of taking Atripla I developed on my inner arms. It has since developed to my thighs, my shins, my feet, the back of my legs, my chest, my neck my shoulders and the palm of my hands. I can also see a couple of red dots on the area between my nose and upper lip. I haven't got it on my lips themselves but they taste slightly odd like if you've had a lot of salt on them though they aren't cracking at all.

I also have psoriasis which had become inflamed. I haven't been using my dovobet recently as it had gotten better but it has become itchy and bumpy in the last couple of days.

Otherwise I feel as good as before I started treatment (this is day 12) even perhaps a little less fatigued in the afternoons and the odd dreams I got initially cleared up after 4 days.

I have had shingles and warts (latter not diagnosed as HPV as I didn't go to docs)

Can IRIS cause inflammation of psoriasis? Is it normal to have rh on such a large area with Atripla? Is widespread rashs sometimes a symptom of IRIS? I have my first appoinment since starting meds on Wednesday but was wondering if I may need to see someone before that to talk about these symptoms.

Thank you very much, 23, male, UK

Response from Dr. Henry

You detail quite well some of the issues to consider in situations such as yours. The rash from efavirenz is often quite diffuse and often will develop after 5-10 days on treatment. It is usually flat and can itch so not usually thick/scaly like one would typically see with psoriasis. Flare-ups of psoriasis as well as immune reconstitution skin manifestations can further complicate determination of what precisely is causing the rash your are experiencing. In most cases one can treat (symptomatically) through an efavirenz rash which usually will start fading after a week or so. I discussion with your HIV provider who would know your existing clinical/dermatological situation even prior to your scheduled clinic visit is warranted if symptoms severe. KH

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