Wednesday, December 23, 2015

80-year-old female patient complains of a 3-day history of a painful rash

An 80-year-old female patient complains of a 3-day history of a painful rash extending over the right half of her forehead and down to her right eyelid. There are weeping vesicular lesions on physical examination. Which of the following is the most likely diagnosis?

zoster :multiple pleomorphic lesion on right side of face



a. Impetigo
b. Adult chickenpox
c. Herpes zoster
d. Coxsackie A virus
e. Herpes simplex


The answer is c.  A painful vesicular rash in a dermatomal distribution strongly suggests herpes zoster, although other viral pathogens may also cause vesicles. Herpes zoster may involve the eyelid when the first or second branch of the fifth cranial nerve is affected. Impetigo is a cellulitis caused by group A β-hemolytic streptococci.


It often involves the face and can occur after an abrasion of the skin. Its distribution is not dermatomal, and while it may cause vesicles, they are usually small and are not weeping fluid. Chickenpox produces vesicles in various stages of development that are diffuse and produce more pruritus than pain.

Coxsackievirus can produce a morbilliform vesiculopustular rash, often with a hemorrhagic component and with lesions of the throat, palms, and soles. Herpes simplex virus causes lesions of the lip (herpes labialis) but does not spread in a dermatomal pattern.

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