Question
What is the diagnosis?
- Chemical burn
- Cicatricial pemphigoid
- Epidermomycosis
- Herpes zoster
- Squamous cell carcinoma
Correct Answer : Herpes zoster
Explanation :
Vesicular, purulent, and crusted lesions consistent with herpes zoster are evident in the ophthalmic distribution of the trigeminal nerve.
The key clinical feature of shingles is a dermatomal eruption of vesicles often preceded by pain and paraesthesia by several days. Erythema precedes the development of vesicles. The vesicles may become pustular 2-3 days following eruption, and may separate a further 3 weeks afterwards. A tender lymphadenopathy (local) is common in the early stages of the rash. There is increased itching and burning. The affected area may remain depigmented and often it is hypoalgesic. A disseminated pattern similar to that of chickenpox, may also occur.
Sites affected:
- most commonly, the lower thoracic region
- ophthalmic division of the trigeminal nerve
- occasionally motor nerves, causing paralysis - for example facial paralysis in Ramsay Hunt syndrome, or urinary retention
This patient completed a 10-day course of oral acyclovir, and clindamycin was added to the regimen for suspected bacterial superinfection.
