Things not to miss - Multidermatomal Herpes Zoster


A 28 years old driver presented to a GP with a painful skin rash. He has had chicken pox when he was 6 years old. He had no other significant past medical history.



GP made the diagnosis of herpes zoster (Shingles) and started him on oral aciclovir 800mg five times a day with oral Panadeine and Gabapentin for pain. He also checked the patient's RBS which was normal.

How would you have managed this patient?

 The diagnosis is correct. It indeed is herpes zoster. However, there is something unusual about the distribution.



If you compare with this picture of dermatomes, you will note that the rash is distributed over more than one dermatome.

In such cases, it is essential to consider underlying immunodeficiencies. In a young patient, HIV should not be missed. Other common causes include diabetes and hematological malignancies.

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