Herpes zoster

Diagnosis: Herpes zoster

Three days earlier with burning pain. No diseases asosiated

Clinical Presentation

Three days earlier with burning pain. No diseases asosiated

Clinical History

Submitted by Humberto Cantu Garza. Originally posted October 21, 2012.

Treatment

See case discussion.

Differential Diagnosis

• Herpes simplex • Contact dermatitis • Cellulitis • Bullous impetigo • Dermatitis herpetiformis • Drug eruption • Insect bites

Key Learnings

• Reactivation of varicella-zoster virus (VZV) from dorsal root ganglia • Dermatomal distribution that does NOT cross the midline is the hallmark • Hutchinson sign: vesicles on tip of nose → nasociliary branch of V1 → ophthalmologic emergency • Ramsay Hunt syndrome: VZV in geniculate ganglion → facial palsy + ear vesicles + otalgia • Post-herpetic neuralgia (PHN) is the most common complication — risk increases with age • Shingrix vaccine (recombinant) >90% effective at preventing zoster — recommended for adults ≥50

Tags: herpes, zoster, humberto cantu garza