27 yrs/f , c/o lesion since 16 hrs.There is pain also. No complain regarding eye. pt had itching 40 hrs back at the site of lesion. It was followed by redness at lesion site after 15 hrs of itching & it was followed by development of yellow pus points 12 hrs later. After more 24 hrs , lesion increased in severity. There is no fever . dx & rx please. Thanks.

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Dr. Harshad Gajjar sir, Thank you for tagging. It is good case. Here visual shows multiple pustules with erythematous base, and pustules may be due to infected viral vesicle lesions by manipulating ( due to desire of itch and duration, according to your history could be 3rd day.) Here V2 dermatome is involved (Trigeminal nerve) . No doubt it could be HERPES ZOSTER. Treatment: Tab Famciclovir 250 mg 3 times daily for 4 days will get good remission. Tab Pregbalin with nortriptyline will give pain relief and save the nerve part to the further injury from this virus. Antihistamines fexofenadine is preferable to alleviate the further itching and inconvenience.

How did u clinically differentiate herpes zoster lesions from herpes simplex lesion in this case ? Because exactly similar picture is also seen in heres simplex lesion . Please help. Thanks.

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Herpes zoster acyclovir skin oint acyclovir Tab 400mg 5hoirly cap gabapentine 300mg bd tabpromethazine bd &ocular Examine daily If & when involved acyclovir Eye oint 5 times

I feel the tightly packed skin lesions are more likely to be Herpes Simplex dermatitis with secondary bacterial infection, Zoster will involve larger area as Ophthalmic dermatome involves forehead & upper lid also. Isolated TORCH test for Herpes Simplex & Zoster can confirm the diagnosis

Herpes simplex type 1

Herpes zoster

Herpes zoster

@Dr. P.kishore Kumar Sir , Please give your opinion. Thanks.

It is herpes simplex lesion.

Look like Herpes Zoster

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