Discussion 12

• The likely diagnosis for this 65-year-old man is shingles, otherwise known as herpes zoster viral infection. Varicella zoster virus reactivation results in the secondary illness known as shingles, which affects nearby nerves and skin. (Sly & Harris, 2018). The dermatomal rash is typically unpleasant yet self-limiting accompanied by pain along the afflicted dermatome, which is usually the first symptom, followed in 2–3 days by a vesicular eruption(Janniger, 2021).
  Clinical presentation can be grouped into three stages: preeruptive phase, acute eruptive phase, and the chronic phase. Early signs and symptoms include:
  • Tingling or burning where the lesions are
  • fever
  • headache
  • myalgia
  • malaise (Sly & Harris, 2018)
  • The acute eruptive phase consists of:
  • development of painful rash
  • tingling in the vicinity of the injured nerve
  • fluid filled blisters arise
  • blisters that were liquid-filled rupture and crust in 7-10 days (Shingles (Herpes Zoster), 2021)
  • The history and physical findings are the main factors used to make a diagnosis. In immunocompromised patients, labwork may be ordered such as:
  • vesicular fluid or a corneal lesion being tested with direct fluorescent antibodies (DFA)
  • polymerase chain reaction (PCR) of blood, vesicular fluid, or a corneal lesion
  • vesicular fluid tzanck smear (Janniger, 2021)
  • Differential Diagnoses include:
  • Acne Keloidalis Nuchae (AKN)
  • acneiform Eruptions
  • allergic Contact Dermatitis
  • cellulitis
  • chickenpox
  • dermatologic Manifestations of Herpes Simplex
  • acneiform Eruptions
  • insect Bites (Janniger, 2021)
  • Antivirals are employed in the treatment of shingles to lessen the duration and intensity of the condition. They ought to be started as soon as the rash shows for the best outcomes. These drugs include acyclovir, valacyclovir, and famciclovir as examples (Shingles (Herpes Zoster), 2021). 

    References
    Janniger, C. K. (2021, August 21). Herpes Zoster. Medscape. https://emedicine.medscape.com/article/1132465-overview
    Shingles (Herpes Zoster). (2021). CDC. https://www.cdc.gov/shingles/index.html
    Sly, J. R., & Harris, A. L. (2018). Recombinant zoster vaccine (shingrix) to prevent herpes zoster. Nursing for Women’s Health, 22(5), 417–422. https://doi.org/10.1016/j.nwh.2018.07.004