Background: Pediatric Human immunodeficiency virus (HIV) infection and its dermatological manifestation has emerged a serious burden globally including India. Dermatological manifestations are unique in pediatric HIV infection and related to CD4 cell count and its percentage. The study was carried out to assess the cutaneous manifestation of HIV positive pediatric patients and its correlation with CD4 cell count in eastern part of India below 12 years of age.Methods: This analytic epidemiological study with prospective observational design was carried among 30 HIV positive children below 12 years of age in our institution over a period of one year.Results: Total 30 HIV infected children were studied among male 23 (76.67%)) and female 7 (23.33%). Age ranged from birth to 12 years with mean was 6.39±2.48 years. The skin lesions are highest in 3-6 yrs age group 12 (40%) and 33.33% of them had CD4 counts between 500-750 while 3.33% had CD4 counts above 1500. 27 patients (90%) were received ART and 3 (10%) patients were without ART. Nine distinct patterns of lesions: abscess (3), furuncles (1), maculopapular rash (2), papular (7), pruritic (10), plaque (3), soreness of tongue (2), pustules (1) and red scaly (1) were detected. 46.67% pain (14), 40.0% itching (12) and 13.33% burning sensation (4) were the main symptoms and 20.0% face (6), 16.7% oral cavity (5), 20.0% hands (6), 10.0% abdomen (3) and 33.3% legs (10) were principal site of involvement. 13 different skin lesions: fungal infection (3), furuncles (1), urticaria (4), scabies (5), prurigo (5), measles (1), molluscum contagiosum (1), abscess (3), venous leg (1), pyoderma (1), atopic dermatitis (1), chicken pox (2) and glossitis (2) were diagnosed.Conclusions: Various dermatological manifestations are common with pediatric HIV infection and sometime are the first clinical presentation that is well correlated with CD4 cell count and its percentage.