Tingling Rash in an Older Manby K. Newman and L Herman

JAAPA 13 (8):21-22

Tingling Rash in an Older Manby K. Newman and L Herman

JAAPA 13 (8):21-22

Presented by Robert HadleyPresented by Robert Hadley

August 29, 2000August 29, 2000

The PublicationThe Publication

Recent PA specialty journal (August, 2000)Recent PA specialty journal (August, 2000) PA authorsPA authors Case presentationCase presentation Presented as a diagnostic challenge with Presented as a diagnostic challenge with

answer and discussion of the DDxanswer and discussion of the DDx

Case PresentationCase Presentation

64 yobm presented to ED c/o pruritic rash on 64 yobm presented to ED c/o pruritic rash on the tip and sides of nose that appeared after the tip and sides of nose that appeared after 5d of pruritis, tingling and burning5d of pruritis, tingling and burning

Began as single, ulcerated lesion surrounded Began as single, ulcerated lesion surrounded by small papules with vesicles.by small papules with vesicles.

No other rashes or lesionsNo other rashes or lesions Denied exposure to new soaps, etc., or Denied exposure to new soaps, etc., or

anyone else with similar rashanyone else with similar rash

Differential DiagnosisDifferential Diagnosis

Acne rosacea?Acne rosacea? Contact dermatitis?Contact dermatitis? Herpes zoster ophthalmicus?Herpes zoster ophthalmicus? Impetigo?Impetigo?

Answer: Herpes zoster ophthalmicusAnswer: Herpes zoster ophthalmicus

Varicella infection of 5th cranial nerveVaricella infection of 5th cranial nerve Nasociliary branch distribution includes tip Nasociliary branch distribution includes tip

of nose and eyeof nose and eye Positive Tzanck test or viral culturePositive Tzanck test or viral culture Optic involvement can cause scarring of Optic involvement can cause scarring of

cornea and loss of sight, as well as cornea and loss of sight, as well as extraocular muscle palsies (weakness)extraocular muscle palsies (weakness)

Emergent ophthalmological consultEmergent ophthalmological consult

Acne Rosacea (adult acne)Acne Rosacea (adult acne)

Chronic condition w/ flushing and Chronic condition w/ flushing and telangectasias in face, often w/ telangectasias in face, often w/ inflammatory papules and pustulesinflammatory papules and pustules

Cause unknown, exacerbated by stress, Cause unknown, exacerbated by stress, EtOH, sunlight, etc.EtOH, sunlight, etc.

Treatment often w/ chronic antibioticsTreatment often w/ chronic antibiotics

Contact DermatitisContact Dermatitis

Sensitization to external agentSensitization to external agent Delayed immune responseDelayed immune response Usually an offending agent can be Usually an offending agent can be

identifiedidentified Distribution of rash is characteristic of Distribution of rash is characteristic of

contact, as in a nickel allergy in a necklace contact, as in a nickel allergy in a necklace patternpattern

ImpetigoImpetigo

Common in childrenCommon in children Superficial skin infection w/ Staph. or Superficial skin infection w/ Staph. or

Strep.Strep. Characteristic weeping sore w/ honey-Characteristic weeping sore w/ honey-

colored crustingcolored crusting

Practical ConsiderationsPractical Considerations

This type of article is clinically very usefulThis type of article is clinically very useful The discussion of differential diagnoses is The discussion of differential diagnoses is

valuable because:valuable because:

A diagnosis that is not entertained will A diagnosis that is not entertained will not be madenot be made

Practical ConsiderationsPractical Considerations

Herpes zoster affecting the eye can cause Herpes zoster affecting the eye can cause blindnessblindness

ALWAYSALWAYS be suspicious of any new lesion be suspicious of any new lesion affecting the tip of the noseaffecting the tip of the nose

Treatment is with antiviral medicationsTreatment is with antiviral medications

Thank YouThank You

Questions?Questions?