Herpes Zoster

Skin Lesion: Grouped vesicles on an erythematous base. Lesions eventually pustulate, ulcerate, and crust over within 7-10 days.

Classic Distribution:

• Dermatomal: Strictly unilateral eruption following a single nerve pathway (dermatome).
• Midline: The rash typically stops abruptly at the body's midline.
• Prodrome: Preceded by 2-3 days of localized pain, tingling, or burning sensation before the rash appears.

Herpes Simplex (HSV)

• The Clue: Recurrent clusters of vesicles usually on the lips or genitalia.
• Vs Zoster: HSV lacks the dramatic dermatomal distribution and is usually more localized. It tends to recur in the same anatomical location.

Impetigo

• The Clue: Rapidly evolving vesicles that rupture to form honey-colored (golden) crusts.
• Vs Zoster: Impetigo is not restricted to a dermatome and is generally less painful. It is highly contagious through direct contact.

🚨 URGENT Referral (Within 24 hours):

• Hutchinson’s Sign: Presence of vesicles on the tip, side, or root of the nose (nasociliary nerve involvement).
• Eye Symptoms: Red eye, blurred vision, or eye pain in a patient with Shingles in the V1 (ophthalmic) distribution.

Antiviral Treatment (Optimal <72h):

• Acyclovir 800mg 5x daily for 7-10 days.
• Valacyclovir 1g TDS for 7 days.
• Famciclovir 500mg TDS for 7 days.

Pain Management:

• Paracetamol 1g TDS
• Voren/Tramadol 50mg PRN
• Postherpetic Neuralgia (PHN): Cap. Gabapentin 300mg TDS.

⚠️ Clinical Pearl: To stay away from pregnant women, neonates, and immunocompromised individuals until all lesions have completely crusted.

📸 Images