Introduction: We describe a case illustrating a rare but increasingly recognised association of chronic actinic dermatitis (CAD) with human immunodeficiency virus (HIV) infection.
Clinical picture: A 40-year-old Chinese man of skin type III presented with a photodistributed rash of 3 years' duration. Histology, phototesting and subsequent clinical course were consistent with CAD. HIV serology was positive. CD4 count was 26 cells/microL, with absence of acquired immunodeficiency syndrome (AIDS)-defining illnesses.
Treatment: Topical steroids, sun-protection and trimethoprim-sulphamethoxazole prophylaxis were prescribed.
Outcome: Improvement was documented over the arms, but the facial plaques persisted.
Conclusion: CAD may be a presenting feature of advanced HIV infection.