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Tingling Rash in an Older Man by K. Newman and L Herman JAAPA 13 (8):21-22

Tingling Rash in an Older Man by K. Newman and L Herman JAAPA 13 (8):21-22. Presented by Robert Hadley August 29, 2000. The Publication. Recent PA specialty journal (August, 2000) PA authors Case presentation Presented as a diagnostic challenge with answer and discussion of the DDx.

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Tingling Rash in an Older Man by K. Newman and L Herman JAAPA 13 (8):21-22

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  1. Tingling Rash in an Older Manby K. Newman and L HermanJAAPA 13 (8):21-22 Presented by Robert Hadley August 29, 2000

  2. The Publication • Recent PA specialty journal (August, 2000) • PA authors • Case presentation • Presented as a diagnostic challenge with answer and discussion of the DDx

  3. Case Presentation • 64 yobm presented to ED c/o pruritic rash on the tip and sides of nose that appeared after 5d of pruritis, tingling and burning • Began as single, ulcerated lesion surrounded by small papules with vesicles. • No other rashes or lesions • Denied exposure to new soaps, etc., or anyone else with similar rash

  4. Differential Diagnosis • Acne rosacea? • Contact dermatitis? • Herpes zoster ophthalmicus? • Impetigo?

  5. Answer: Herpes zoster ophthalmicus • Varicella infection of 5th cranial nerve • Nasociliary branch distribution includes tip of nose and eye • Positive Tzanck test or viral culture • Optic involvement can cause scarring of cornea and loss of sight, as well as extraocular muscle palsies (weakness) • Emergent ophthalmological consult

  6. Acne Rosacea (adult acne) • Chronic condition w/ flushing and telangectasias in face, often w/ inflammatory papules and pustules • Cause unknown, exacerbated by stress, EtOH, sunlight, etc. • Treatment often w/ chronic antibiotics

  7. Contact Dermatitis • Sensitization to external agent • Delayed immune response • Usually an offending agent can be identified • Distribution of rash is characteristic of contact, as in a nickel allergy in a necklace pattern

  8. Impetigo • Common in children • Superficial skin infection w/ Staph. or Strep. • Characteristic weeping sore w/ honey-colored crusting

  9. Practical Considerations • This type of article is clinically very useful • The discussion of differential diagnoses is valuable because: • A diagnosis that is not entertained will not be made

  10. Practical Considerations • Herpes zoster affecting the eye can cause blindness • ALWAYS be suspicious of any new lesion affecting the tip of the nose • Treatment is with antiviral medications

  11. Thank You • Questions?

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