Tingling Rash in an Older Man by K. Newman and L Herman JAAPA 13 (8):21-22 Presented by Robert Hadley August 29, 2000

The Publication ä Recent PA specialty journal (August, 2000) ä PA authors ä Case presentation ä Presented as a diagnostic challenge with answer and discussion of the DDx

Case Presentation ä 64 yobm presented to ED c/o pruritic rash on the tip and sides of nose that appeared after 5d of pruritis, tingling and burning ä Began as single, ulcerated lesion surrounded by small papules with vesicles. ä No other rashes or lesions ä Denied exposure to new soaps, etc., or anyone else with similar rash

Differential Diagnosis ä Acne rosacea? ä Contact dermatitis? ä Herpes zoster ophthalmicus? ä Impetigo?

Answer: Herpes zoster ophthalmicus ä Varicella infection of 5th cranial nerve ä Nasociliary branch distribution includes tip of nose and eye ä Positive Tzanck test or viral culture ä Optic involvement can cause scarring of cornea and loss of sight, as well as extraocular muscle palsies (weakness) ä Emergent ophthalmological consult

Acne Rosacea (adult acne) ä Chronic condition w/ flushing and telangectasias in face, often w/ inflammatory papules and pustules ä Cause unknown, exacerbated by stress, EtOH, sunlight, etc. ä Treatment often w/ chronic antibiotics

Contact Dermatitis ä Sensitization to external agent ä Delayed immune response ä Usually an offending agent can be identified ä Distribution of rash is characteristic of contact, as in a nickel allergy in a necklace pattern

Impetigo ä Common in children ä Superficial skin infection w/ Staph. or Strep. ä Characteristic weeping sore w/ honey- colored crusting

Practical Considerations ä This type of article is clinically very useful ä The discussion of differential diagnoses is valuable because: A diagnosis that is not entertained will not be made A diagnosis that is not entertained will not be made

Practical Considerations ä Herpes zoster affecting the eye can cause blindness ä ALWAYS be suspicious of any new lesion affecting the tip of the nose ä Treatment is with antiviral medications

Thank You  Questions?