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GENERALISED ITCHY RASHIf status unknown, test for HIV, especially if rash is extensive, recurrent and difficult to treat 60.A widespread very itchy rash withburrowsVery itchy bumps.Skin often hyper-pigmentedPatches of dry, scaly skinwith/without itchthat may be localisedVery itchy red raised wheals thatappear suddenly, disappear and thenreappear elsewhereScabies likelyCommonly involves web-spaces ofhands and feet, axillae and genitalia.• Prescribe 25% benzyl benzoatelotion.• Apply, leave to dry, wash off after 24hrs, repeat after 1 week (repeat onceonly).• Treat all household members andclean linen/clothes.• For itch: chlorpheniramine 4mg atnight up to 10 days.Papular-pruritic eruption likely• Often co-exists with scabies.• Usually seen in HIV patients 60.• May temporarily worsen on startingART.• A stage 2 HIV condition. HIV patientneeds routine HIV care 61.• First treat as for scabies in adjacentcolumn.• If no response, give emulsifyingointment and 1% hydrocortisonecream.• For itch: chlorpheniramine 4mg8 hourly up to 5 days.• If poor response doctor to givebetamethasone 0.1% ointment twicea day for 7 days (do not apply to face).Eczema likely• Use emulsifying ointment instead ofsoap.• Prescribe 1% hydrocortisone cream.• Use aqueous cream as a moisturiser.• For itch: chlorpheniramine 4mg8 hourly up to 5 days or cetirizine 10mgat night long term as needed..• If infected, treat with flucloxacillin500mg 6 hourly for 5 days. If penicillinallergic give erythromycin 500mg 6hourly for 5 days.• If poor response doctor to givebetamethasone 0.1% ointment twice aday for 7 days (do not apply to face).• Refer if no better with above treatment.Urticaria likelyCommonly due to allergy• Try to identify and remove allergen.• Stop offending drug and prescribealternative if necessary.• Calamine lotion directly on rash asneeded.• Chlorpheniramine 4mg 8 hourly until72 hours after resolution of wheals.• Refer if no better in 24 hours.If no response to treatment, refer for specialist review.43