Jean, 63 years old, Facial rash

Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.

23 respondents

Question of 1

True answer!

Shingles

It is indeed shingles.

Let’s rule out differential diagnoses:

Acute, sudden and rapidly spreading: not suggestive of a cutaneous tumoural disease.
No tumoural appearance
Vesicular primary lesion
Inflammatory background
Meliceric crusts
Metameric pattern +++: key factor in the diagnosis (≠ acute impetiginised eczema)
No oedema and diffuse pronounced erythema, no increase in local skin temperature, no fever: no arguments in favour of erysipelas BUT possible progression if secondary infection is not treated.

Wrong answer!

It was shingles.

Let’s rule out differential diagnoses:

Acute, sudden and rapidly spreading: not suggestive of a cutaneous tumoural disease.
No tumoural appearance
Vesicular primary lesion
Inflammatory background
Meliceric crusts
Metameric pattern +++: key factor in the diagnosis (≠ acute impetiginised eczema)
No oedema and diffuse pronounced erythema, no increase in local skin temperature, no fever: no arguments in favour of erysipelas BUT possible progression if secondary infection is not treated.

Wrong answer!

It was shingles.

Let’s rule out differential diagnoses:

Acute, sudden and rapidly spreading: not suggestive of a cutaneous tumoural disease.
No tumoural appearance
Vesicular primary lesion
Inflammatory background
Meliceric crusts
Metameric pattern +++: key factor in the diagnosis (≠ acute impetiginised eczema)
No oedema and diffuse pronounced erythema, no increase in local skin temperature, no fever: no arguments in favour of erysipelas BUT possible progression if secondary infection is not treated.

Wrong answer!

It was shingles.

Let’s rule out differential diagnoses:

Acute, sudden and rapidly spreading: not suggestive of a cutaneous tumoural disease.
No tumoural appearance
Vesicular primary lesion
Inflammatory background
Meliceric crusts
Metameric pattern +++: key factor in the diagnosis (≠ acute impetiginised eczema)
No oedema and diffuse pronounced erythema, no increase in local skin temperature, no fever: no arguments in favour of erysipelas BUT possible progression if secondary infection is not treated.

Context: Non-immunocompromised male in his sixties
Primary lesions:
- Vesicles, grouped in clusters
- Pustules
- Erythematous inflammatory background
Secondary lesions:
- Meliceric crusts = secondary infection
- Erosions on the oral mucosa
Location/Pattern:
- Key factor in the diagnosis +++
- Face: skin AND oral mucosa
- Unilateral metameric pattern, along the V2 nerve
Associated signs:
- Pain: neuropathic; often starts before the eruption
- No pruritus
- No fever but adenopathy may be found in the drainage region

When faced with a painful, vesicular, unilateral and metameric dermatosis, evoke the diagnosis of shingles
Facial shingles: investigate mucosal involvement (oral: V2, ocular: V1)
HIV serology: testing recommended in at-risk subjects

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