A 46-year-old man with HIV/AIDS (CD4 count 6, HIV Viral Load 134,530) complained of chronic pruritus. Excoriated lichenified plaques were present on the hands, face, neck, trunk, axillae, bilateral arms, abdomen, groin, buttocks, and legs. One year earlier he was diagnosed with crusted scabies and underwent treatment with a topical scabicide. Repeat evaluation for scabies did not reveal any mites, ova, or feces. He was diagnosed with HIVassociated pruritus. Pruritus occurs in up to 30% of patients with HIV. Evaluation of pruritus should include a careful examination of the skin, hair, nails, and mucous membranes to establish a primary dermatologic diagnosis. If a dermatologic diagnosis is not found, a systemic or medication related cause should be sought. Idiopathic HIV-associated pruritus is a diagnosis of exclusion. Pruritus may be intractable and provoke scratching, picking, disfigurement, sleep loss, and significant psychological stress. Phototherapy has been found to be useful in the treatment of several HIV associated dermatoses and idiopathic pruritus.