Painful Eruption Research Articles

Diagnostic pitfalls of varicella virus infection in adults

Case report We present three cases of previously healthy adult patients diagnosed with varicella in December 2012 with uncommon onsets, but with mild evolution of the disease. Patient 1: female, age 45, had an atypical onset with very few vesicles only one on the trunk, and then on the head after five days, but with inflammatory occipital lymph nodes. From day 6, our patient had typical dermatological lesions, mild pruritus and only two days of mild fever. Patient 2: male, age 38, had a typical onset, with high fever in the first week. With another episode of varicella in his childhood, this was considered as a varicella virus recurrent infection. Patient 3: male, age 80, was admitted to the hospital for extremely painful cutaneous eruptions on the thorax, initially diagnosed as zona zoster. In the next days, the lesions, in different stages of development, extended all over the body, with typical evolution of chickenpox. All patients were treated with supportive therapy: antipruritic and anti-inflammatory drug mouthwashes, soothing topical lotions and anesthetic gels. They had self-limited evolution, with no complications and with complete remission of lesions.

An unusual and painful plantar eruption

Tiffany Washkewicz practices dermatology at multiple Cleveland Clinic Family Health and Surgical Centers in Cleveland, Ohio. The author has indicated no relationships to disclose relating to the content of this article.

Vegetative Plaques and Hemorrhagic Pustules

A man with a history of chronic renal insufficiency (baseline creatinine level, 2.8mg/dL) presented for evaluation of a painful forehead erythematous eruption and associated headache. (To convert creatinine to micromoles per liter, multiply by 88.4.) Three days prior to symptom onset he underwent a contrast-enhanced computed tomographic (CT) scan to evaluate abdominal pain. On the central forehead was a tender 5-cm reddish brown plaque composed of numerous coalescing vesicles and hemorrhagic pustules with intermixed serous and hemorrhagic crust. Similar vesicles and pustules were present on the nasal bridge and tip, the bilateral conchal bowls, and on the scalp (Figure, A). Two days later, the patient developed several 0.5to 1.0-cm purpuric macules and hemorrhagic vesicles on the bilateral hands and nail beds. Initial blood tests revealed a white blood cell count of 6400 cells (range, 4000 to 11 000/μL; to convert to ×109/L, multiply by 0.001). The patient denied any new medications, any known contacts with or exposures to individuals who were ill, and any history of skin disease. A punch biopsy of the forehead plaque was performed (Figure, B and C). What is your diagnosis?

Herpes Zoster: Diagnostic, Therapeutic, and Preventive Approaches

Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pre-gabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.

A woman with a painful eruption following liver transplantation

A 29-year-old woman with hepatitis C presented 2years after an orthotopic liver transplant with several weeks of fevers, abdominal pain, nausea, and a painful ulcerated nodular eruption on her abdomen and lower extremities. The patient was evaluated, and her case is presented and the differential discussed.

A 3-Year-Old Girl with a Painful Skin Eruption

CME EDUCATIONAL OBJECTIVES1.Identify clinical lesions of shingles.2.Describe the importance of the attenuated varicella vaccine and its impact on shingles presentation.3.Discuss treatment options for patients with shingles. A 3-year-old, otherwise healthy female, presented to the dermatology clinic for evaluation of a painful eruption on her right arm and back. It had been present for 6 days, and had started as a single blister on her right fourth digit. Over several days, new lesions appeared on her right hand, forearm, arm, and back. All lesions were painful and pruritic. She was afebrile and otherwise felt well. Her vaccinations were all up to date. A review of systems was unremarkable; family history was noncontributory.

Atypical presentation of herpes zoster in a case with acute myeloblastic leukemia

Abstract Herpes zoster (HZ) is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Approximately 10% to 30% of the population will suffer from HZ during their lifetime. HZ is infrequent in healthy children. However, diminished cellular immunity seems to increase risk of reactivation because incidence increases with age and in immunocompromised states. We report a 7-year-old girl with acute myeloblastic leukemia HZ infection on the right palmar, elbow and forearm region (C7, C8 and T1 dermatomes). We want to indicate unusual localization of HZ on the acute myeloblastic leukemia child patient.

Horner's Syndrome and Contralateral Abducens Nerve Palsy Associated with Zoster Meningitis

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.

A case of almost painless herpes zoster presenting with symptoms of cystitis, penile numbness, and acute vestibular failure.

Herpes zoster (shingles) is an acute, painful, vesicular, and cutaneous eruption caused by varicella zoster virus, the same virus which causes chicken pox. It is due to the reactivation of the virus which remains dormant in sensory ganglions following chicken pox. It is usually confined to a single dermatome but may involve 2-3 dermatomes. Typically, it is a unilateral lesion which can affect both cranial and peripheral nerves. It is usually a self-limiting disease; however, it may cause significant morbidity especially in the elderly. It is more common in older people and individuals with immunocompromised conditions. Antiviral drugs can shorten the duration and the severity of the illness and need to be started as soon as possible after the appearance of the rash. Gabapentin and tricyclic antidepressant are effective in postherpetic neuralgia. Vaccine can reduce the risk of infection and its associated pain. Typically, it occurs once in a lifetime, but some individuals may have more than one episode.

Palmoplantar pustulosis

See also practice article by Lee and Ladizinski at [www.cmaj.ca/lookup/doi/10.1503/cmaj.121036][1] A 46-year-old woman presented with a 5-year history of recurrent and painful eruptions of pustules on her palms and the soles of her feet that resolved with red–brown discolouration. She did not

Rivaroxaban: Another Treatment for Livedoid Vasculopathy?

Livedoid vasculopathy is a chronic, often painful eruption of recurrent, small ulcerations, usually affecting the lower legs. This condition has been

A painful eruption in a woman with Darier disease

A 48-year-old white woman with a history of Darier disease presented with an acute painful and burning eruption on her chest. She had been treated for previous flares of her disease with topical triamcinolone and drying powders, but stated that this eruption was not responding to these usual treatments. Days before her presentation, she had been given narcotics and minocycline for presumed impetiginization without an improvement in the rash or her level of pain.

Acute skin rash in a gentleman with gout

From Ta Fund Conf Repr D A 49-year-old Asian man with a history of gouty arthritis presented to our dermatology clinic with an abrupt onset of a slightly painful eruption. He began taking allopurinol for his painful joints yesterday. Upon further inquiry, he defined similar symptoms that occurred a year ago after receiving another drug for his gout. The physical examination was notable for multiple circumscribed violaceous macules and patches over his left trunk and pelvic area (the photograph in Fig 1 was taken a year ago; the photograph in Fig 2 was taken during the current episode).

A 69-year-old man with a painful vesicular rash

A previously healthy 69-year-old man presents to his primary care physician with a painful vesicular eruption of 24 hours’ duration. He recalls that his 65-year-old brother had a similar rash one year earlier, which had been diagnosed as shingles. He wants to know what can be done to prevent the

Syndrome de Stevens-Johnson après ingestion de poudre à canon

A cutaneous adverse drug reaction is a skin eruption secondary to the intake of a drug, be it prescribed by a medical practitioner or taken as auto-medication for a given ailment. In this document we present an original case of Stevens-Johnson's syndrome secondary to the ingestion of gunpowder. A 22-year-old female student was hospitalised for diffuse and painful skin eruptions for the previous three days. She had complained six days earlier of an allergic reaction to pineapples, an allergy she had presented for quite a long time. In an attempt to remedy the situation, her mother made her drink a solution made of gunpowder bought at a market mixed with some water. On the third day of this "treatment", the patient noticed eruptions on her skin. These were initially maculopapular, later becoming erosive, and she had a mild fever. Later, a variety of eruptions appeared on the skin, from hyper-pigmented macular papules to blisters and erosive lesions with no Nicolsky sign. These lesions spared the palms of the hands and the soles of the feet. The mucosa of the conjunctivae, nose, buccal cavity, vulva, vagina and anus were severely affected. This clinical presentation was typical of Steven Johnson syndrome. The patient had stopped taking the "treatment" when she noticed the first lesions. On therapy, the outcome was favourable, except for severe complications such as synechiae with diffuse dyschromia. To the best of our knowledge this is the first time gunpowder has been incriminated in Stevens-Johnson's syndrome.

Ethambutol and pyrazinamide-induced toxic epidermal necrolysis in an immunocompetent adult with tuberculosis

Ethambutol and pyrazinamide-induced toxic epidermal necrolysis in an immunocompetent adult with tuberculosis

Erythema Annulare Centrifugum Associated with Herpes Zoster

Erythema annulare centrifugum (EAC) presents as erythematous or urticarial papules, each with an annular shape, that exhibit peripheral extension. Internal malignancies are occasionally associated with EAC, and infectious diseases, including fungal, bacterial or viral infections, have also been regarded as possible causes of EAC. A 35-year-old man had a 1-week history of a painful vesicular eruption over the trunk corresponding to dermatomes Th8-10. Concomitantly, he developed several annular eruptions over the trunk. We diagnosed the former lesions as herpes zoster and the latter as EAC associated with herpes zoster. Although DNA was extracted from the EAC region, no varicella-zoster virus DNA was detected. We consider that this is Wolf's isotopic response, which is caused by an alteration of the local immunity due to viral infection. An etiologic relationship between EAC and herpes zoster is strongly suggested by the present case and by our review.

More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's isotopic response in an Asian female

Introduction: Wolf’s isotopic response is a rare dermatologic phenomenon defined as the occurrence of a new, unrelated disease at the site of healed lesions of some other disease. We report the first case of Wolf’s isotopic response in a female presenting with rosacea localized to the site of healing zoster lesions. Case Report: A 35­year­old previously healthy Filipino­American woman with no prior history of a dermatologic condition presented to our clinic with a 9­month history of a painful and pruritic unilateral erythematous papular eruption on her right upper cutaneous lip and cheek that respected the midline. At initial presentation she was started on 800 mg acyclovir five times daily for one week for presumed zoster. Four days into her seven­day acyclovir course, her primary care physician obtained cultures for VZV and HSV, but these tests were negative. The vesicular eruptions completely resolved following treatment with acyclovir, leaving only hyperpigmented scars in the unilateral maxillary distribution. Two months after the completion of her acyclovir treatment, she noticed pink dots, which had a prickly and itchy sensation located in the same unilateral distribution as her previous eruptions. Her condition was refractory to a myriad of topical treatments and a skin biopsy was performed which suggested acne rosacea. She was started on isotretinoin and continued for five months with almost complete resolution of papules and symptoms. Conclusion: The pathogenesis of Wolf’s isotopic response is unknown. We review the various etiologies that have been postulated including direct action of viral, particles, immune activation, alterations in neurologic system and vascular changes. Early recognition of Wolf’s isotopic response may result in more timely and effective treatment for patients. Further studies are needed to define the pathogenesis of isotopic response.

Alveolar bone necrosis and spontaneous tooth exfoliation associated with trigeminal herpes zoster: a report of three cases

J Korean Assoc Oral Maxillofac Surg 2012;38:177-83) Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus, an infection most commonly affecting the thoracolumbar trunk. Herpes Zoster Infection (HZI) may affect the cranial nerves, most frequently the trigeminal. HZI of the trigeminal nerve distribution network manifests as multiple, painful vesicular eruptions of the skin and mucosa which are innervated by the infected nerves. Oral vesicles usually appear after the skin manifestations. The vesicles rupture and coalesce, leaving mucosal erosions without subsequent scarring in most cases. The worst complication of HZI is post-herpetic neuralgia; other complications include facial scarring, motor nerve palsy and optic neuropathy. Osteonecrosis with spontaneous exfoliation of the teeth is an uncommon complication associated with HZI of the trigeminal nerve. We report several cases of osteomyelitis appearing on the mandible, caused by HZI, and triggering osteonecrosis or spontaneous tooth exfoliation.

Herpes Zoster: Report of a Treated Case with Review of Literature

Herpes zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromized persons. It is caused by reactivation of latent varicella zoster virus (VZV). Approximately one in three persons will develop zoster during their lifetime. A common complication of zoster is postherpetic neuralgia (PHN), a chronic, often debilitating pain condition that can last months or even years. The risk for PHN in patients with zoster is 10 to 18%. Approximately 3% of patients with zoster are hospitalized. Death attributable to zoster are common among immunocompromized persons. Prompt treatment with the oral antiviral agents, corticosteroids and analgesics decreases the severity and duration of acute pain from zoster. This article reviews herpes zoster and reports one such case, which was treated successfully without any complications.