A 24-year-old woman, known to be human immunodeficiency virus positive for 6 years, presented with an itchy rash on the body. She had dull erythematous to hyperpigmented scaly plaques over the body, with extensor predominance. Inflammatory papules and nodules were noted on the face. Follicular hyperkeratotic papules were seen on the shins, giving a "nutmeg grater" feel. All her nails were dystrophic. Histopathology was consistent with the clinical diagnosis of pityriasis rubra pilaris. CD4 counts had dropped to 192 cells/μl, so she was started on antiretroviral therapy along with acitretin to which she responded well within 2 months.