28yr Female 22wks of gestation.. came with complain of Raised water filled small vesicles on Arm medial aspect.. severe itching with pain & inflammation. after 2days the (images at present) vesicles hav ruptured due to scratching with depressed blackish (umbilicated) to touch scars. no h/o fever no h/o pain in any joints no h/o atopy/DM/HTN non contributory medical or surgical history its constant in size didnt increase nor spreading its raised ..erythematous, painful with swelling around.. kindly help in diagnosis

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Sir the lesions are not in groups, as in case of HSV nor black topped. The vesicles rupture and ooze than dryup. So it is not Herpes simplex it is not dermatomal and HZ lesions run a longer course, and do2 sjow up the black top. The black top is not scar as felt by the doc but is a dried up vesicle atop a papule which is charateristic of papular urticaria which is a reaction to some insect/ bug.

Agree with you sir... Thanks for valuable input
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Papular urticaria. Papule topped with a dried up vesicle , (seen as black dot). Lesions look targetoid but true EmF is not localised. Antihistominic orally and calamine locally and a mild steroid cream at night.

I too thought of Herpes but lesion is constant not increasing.. moderate pain n swelling no fever ... Herpes has severe pain n vesicles are bigger in size...

Sir the lesion is one group of vesicles . How much a tiny vesicle is expected to visibly ooz , now it is more than 2 days so it is drying up. To say that the distribution is dermatomal more than one group of lesion is needed , but if only one group of lesion is present that does not rule out HZ on that account . All grades of severity are seen in HZ ranging from zoster sine herpes to gangrenous zoster . Some times it is so mild that it might pass un noticed .Healing may take one week to 2 months . clinicaly it is difficult to distinguish between HS and HZ if the former is not at it's common sites or dermatomal distribution is not obvious . Papular urticaria is usualy seen in childern . More over insect bite is usualy seen in linear fashion commonly called as breakfast, lunch and dinner bites . ( three bites) not multiple bites at one place , here about 13 of bites if so .

Sir , we know that insect bites r BF, L... and D... I wonder whether the insect kows it or would satisfy with just 3 bites. More over .y diagnosis is papular urticaria which are allergic response to a bite ( mot exactly bote) and hence can be multiple. It is unusual for HZ TO DESSICATE IN TWO DAYS. THE WHOLE SET OF LESIOMS CAN NOT NE CALLED GROUPING, ; ITS ' DISTRIBUTION OF SCATTERED LESIONS'. MY DIAGNOSIS IS BY MORPHOLOGY OF EACH LESION.
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Herpes zoster. Treat with local and systemic anti viral , and symptomatic and suppirtive. No effect on fetus at this gestation.

I will go with the diagnosis of Herpes Zoster.

Insect bites reaction

Thanks Dr A Dutta
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Allergic reaction of some insect bite No HZ or HS

NO FEVER, NO JOINT PAIN, BURNING SENSATION I THINK ACD NOT HERPES GIVE CLOBETASONE +SSA APPLY BD

Pederous dermatitis

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