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What Does A Painful Rash Near The Gluteal Fold Indicate?
A 72-year-old female presents with complaints of a rash near the gluteal fold on the right side. It is a painful vesicular rash, onset approximately 2 days ago, with no fever but occasional burning and sensitivity at the site. She has tried triple antibiotic ointment without relief. She has been widowed for 10 years and has a steady boyfriend whom she has dated for 6 months and recently became sexually active with. What other questions would you like to ask your patient? What are your differential diagnoses and final diagnosis? How would you discuss this diagnosis with your older patient?
Sat, 3 Nov 2018
Hi,
Unilateral painful vesicular rash in an elderly is suggestive of herpes zoster. Is she on steroid or some immunosuppressive drug recently?
Antiviral therapy is begun immediately using Acyclovir, Valacyclovir preferably within 72h of the appearance of the first vesicle.
Symptoms are managed with bed rest, opioid analgesics, capsaicin cream, NSAIDs, tricyclic antidepressants and, in severe cases of pain, nerve blocks.
Differential diagnosis: Dermatitis herpetiformis commonly seen in buttocks but these are pruritic and not unilateral-usually distributed symmetrically.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Tushar Kanti Biswas,
Internal Medicine Specialist
Unilateral painful vesicular rash in an elderly is suggestive of herpes zoster. Is she on steroid or some immunosuppressive drug recently?
Antiviral therapy is begun immediately using Acyclovir, Valacyclovir preferably within 72h of the appearance of the first vesicle.
Symptoms are managed with bed rest, opioid analgesics, capsaicin cream, NSAIDs, tricyclic antidepressants and, in severe cases of pain, nerve blocks.
Differential diagnosis: Dermatitis herpetiformis commonly seen in buttocks but these are pruritic and not unilateral-usually distributed symmetrically.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Tushar Kanti Biswas,
Internal Medicine Specialist
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