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GENERALISED NON ITCHY RED RASHIs patient taking any medication?• Presentation is variable, frommild, patchy spots on the trunk towidespread skin damage (like burns).• Hand involvement is characteristic.• May occur within 6 weeks of startingor restarting antiretrovirals especiallynevirapine, TB drugs, anticonvulsants,penicillin or co-trimoxazole.YesDrug reaction likelyDoes the patient have any of the following markers of severity:• Temperature ≥ 38°C• Painful mouth, eyes or genitals• Vomiting or nausea• Blistering or ‘raw’ areas• Headache• Diffuse purple discolouration of skin• Jaundice• Abdominal painNo• Most likely due to infection.• Patient may have fever, headache, lymphadenopathy, muscle pain.• Ensure patient is not severely ill 40.Treatment of patient who is not severely ill• Give pain relief if needed. Paracetamol 1g 6 hourly.• Check for syphilis.• If status unknown, test for HIV 60.Syphilis test positive or unavailableAbout one third of patients withuntreated primary syphilis developsecondary syphilis.Rash is often on soles and palms.There may also be condylomata lata andpatchy hairloss.HIV negativeRash may be an HIVseroconversion illness.Advise patient torepeat HIV test after 3months.HIV positivePatient needsroutine HIV care61.YesPatient is severely ill.NoPatient is not severely ill.• Stop all drugs.• Refer to hospital same day.• Patient must continue with medication. Do notincrease nevirapine if still on once daily dose untilrash has resolved and ALT is normal.• Check ALT.--If ≥ 200 refer same day.--If 50–199 and patient is well, repeat ALT after1 week.• Apply emulsifying ointment.• Chlorpheniramine 4mg at night if itchy up to 5 days.• Review daily until rash resolves.• Advise patient to return urgently if markers ofseverity develop.Treat patient for early syphilis 28.45