Teaching rounds today - 32 y/o female with several medical problems, to include celiac disease (? Dx) and a history of recurrent vesicular lesions on her forehead diagnosed as zoster.
The differential diagnosis of vesicular rash includes a variety of infectious and noninfectious causes - some benign and some potentially fatal. Varicella, HSV, vaccinia virus, variola virus, enterovirus, rickettsialpox, impetigo, dermatitis herpetiformis, phytodermatitis, and phytophotodermatitis all need to be considered in the correct clinical setting.
Scraping of the vesicle base to obtain cells for DFA is my preferred method for rapid HSV diagnosis, and probes are available for HSV1, HSV2, and VZV. This article has a summary of the collection procedure as well as other diagnostic methods for herpes virus infections.
Yes, phytophotodermatitis exists - so beware all those mojitos, gin&tonics, coronas, margaritas, and any other lime containing beverage out in the sun this summer.
One recent case in the ID literature emphasizes the importance of making a definite diagnosis - Kaposi varicelliform eruption - generalized vesicular rash that mimics chickenpox but is caused by HSV or coxsackie virus. Pts with a history of eczema are at significant risk for this.
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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