Herpes zoster differential diagnosis: Difference between revisions

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__NOTOC__
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{{Herpes zoster}}
{{Herpes zoster}}
{{CMG}}; L. Katie Morrison, MD; {{AE}} {{VK}}
{{CMG}}; L. Katie Morrison, MD; {{AE}} {{VK}}; {{JS}}; {{SaraM}}


==Overview==
==Overview==
[[Diagnosis]] of Herpes zoster might not be possible in the absence of a [[rash]] (i.e., before rash or in cases of zoster without rash). It is sometimes confused with [[herpes simplex]], and, occasionally, with [[impetigo]], [[contact dermatitis]], [[folliculitis]], [[scabies]], [[insect bite]]s, [[papule|papular]] [[urticaria]], [[candidiasis|candidal infection]], [[dermatitis herpetiformis]], and [[drug eruption]]s.
[[Diagnosis]] of Herpes zoster might not be possible in the absence of a [[rash]] (i.e., before rash or in cases of zoster without rash). It is sometimes confused with [[herpes simplex]], and, occasionally, with [[impetigo]], [[contact dermatitis]], [[folliculitis]], [[scabies]], [[insect bite]]s, [[papule|papular]] [[urticaria]], [[candidiasis|candidal infection]], [[dermatitis herpetiformis]], and [[drug eruption]]s.
==Differential Diagnosis==
For rash:
* [[Atopic dermatitis]]
* Atypical [[measles]]
* [[Coxsackievirus]] infections
* Pyoderma
*[[Herpes simplex]]
*[[Impetigo]]
*[[Contact dermatitis]]
*[[Folliculitis]]
*[[Scabies]]
*[[Insect bite]]s
*[[Papule|Papular]] [[urticaria]]
*[[Candidiasis|Candidal infection]]
*[[Dermatitis herpetiformis]]
*[[Drug eruption]]s.


For pain symptoms depending on the location:
==Differentiating Herpes Zoster from other Diseases==
Skin lesions caused by Herpes Zoster infection must be differentiated from:<ref name="pmid17143845">{{cite journal| author=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M et al.| title=Recommendations for the management of herpes zoster. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 1 | issue=  | pages= S1-26 | pmid=17143845 | doi=10.1086/510206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143845  }} </ref><ref name="pmid17939933">{{cite journal |author=Fatahzadeh M, Schwartz RA |title=Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management |journal=J. Am. Acad. Dermatol. |volume=57 |issue=5 |pages=737–63; quiz 764–6 |year=2007 |pmid=17939933 |doi=10.1016/j.jaad.2007.06.027}}</ref><ref name=Baron>{{cite book | author = Walsh TJ, Dixon DM | chapter=Deep Mycoses |title=Baron's Medical Microbiology |editor=Baron S ''et al'' eds.| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 |isbn=0-9631172-1-1 |url=http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.4006 |format=via NCBI Bookshelf}}</ref><ref name="Pappas">{{cite journal |author=Pappas PG |title=Invasive candidiasis |journal=Infect. Dis. Clin. North Am. |volume=20 |issue=3 |pages=485–506 |year=2006 |pmid=16984866 |doi=10.1016/j.idc.2006.07.004}}</ref><ref name="pmid12721927">{{cite journal| author=Bellini WJ, Helfand RF| title=The challenges and strategies for laboratory diagnosis of measles in an international setting. | journal=J Infect Dis | year= 2003 | volume= 187 Suppl 1 | issue=  | pages= S283-90 | pmid=12721927 | doi=10.1086/368040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12721927  }} </ref><ref name="pmid4263498">{{cite journal| author=Dajani AS, Ferrieri P, Wannamaker LW| title=Natural history of impetigo. II. Etiologic agents and bacterial interactions. | journal=J Clin Invest | year= 1972 | volume= 51 | issue= 11 | pages= 2863-71 | pmid=4263498 | doi=10.1172/JCI107109 | pmc=292435 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4263498  }} </ref><ref name="pmid13876790">{{cite journal| author=CARPENTER RR, PETERSDORF RG| title=The clinical spectrum of bacterial meningitis. | journal=Am J Med | year= 1962 | volume= 33 | issue=  | pages= 262-75 | pmid=13876790 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13876790  }} </ref><ref name="pmid21571167">{{cite journal| author=Bolotin D, Petronic-Rosic V| title=Dermatitis herpetiformis. Part I. Epidemiology, pathogenesis, and clinical presentation. | journal=J Am Acad Dermatol | year= 2011 | volume= 64 | issue= 6 | pages= 1017-24; quiz 1025-6 | pmid=21571167 | doi=10.1016/j.jaad.2010.09.777 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21571167  }} </ref><ref name="pmid23972567">{{cite journal| author=Chen X, Anstey AV, Bugert JJ| title=Molluscum contagiosum virus infection. | journal=Lancet Infect Dis | year= 2013 | volume= 13 | issue= 10 | pages= 877-88 | pmid=23972567 | doi=10.1016/S1473-3099(13)70109-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23972567  }} </ref>
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Atopic dermatitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*The [[skin]] of a patient with [[atopic dermatitis]] reacts abnormally to irritants such as food and environmental allergens
*The [[skin]] on the flexural surfaces of the [[joints]] (elbows and knees) are most commonly affected regions
*It usually present with red, flaky and very itchy skin
*It also becomes vulnerable to surface [[infections]] caused by [[bacteria]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Pyoderma gangrenosum]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*It usually occurs on the [[legs]]
*[[Ulcers]] initially look like small bug bites or [[papules]], and later progress to larger [[ulcers]] that may become [[necrotic]]
*Ulcers can cause [[pain]] and [[scarring]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Herpes simplex]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Primary orofacial [[herpes]]/HSV-1 presents itself as multiple, round, superficial [[oral ulcer]]s
*[[Genital herpes]]/HSV-2 can be more difficult to diagnose than [[oral herpes]] since most HSV-2-infected persons have no classical [[signs]] and [[symptoms]]
*Adults with non-typical presentation are more difficult to diagnose. However, [[prodromal symptoms]] that occur before the appearance of herpetic lesions helps to differentiate [[HSV]] from other conditions
*[[Herpes simplex|Herpes infection]] can recur even after successful initial treatment. The first episode is usually longer (two to four weeks) more painful and severe than the recurrent episodes
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Contact dermatitis]] '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Skin]] reaction resulting from exposure to [[allergens]], irritants or sunlight
*It usually presents as a localized [[rash]] or irritation of the skin only on the superficial regions of the skin
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Folliculitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*It starts when [[hair follicles]] are damaged by friction from clothing, blockage of the follicle, or shaving
*In most cases of [[folliculitis]] the damaged follicles are then [[infected]] with the [[bacteria]] [[Staphylococcus]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Scabies]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Transmissible [[Parasitism|ectoparasite]] [[skin]] [[infection]] characterized by superficial burrows, intense pruritus and [[secondary infection]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Papule|Papular]] [[urticaria]] '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Skin]] condition, commonly caused by an [[allergic reaction]] commonly caused by direct contact with an allergenic substance, or an [[immune response]] to food, other [[allergen]], or emotional stress
*The [[rash]] can be triggered by quite innocent events, such as mere rubbing or exposure to cold.
*It is characterized by raised red [[skin]] welts. Welts from hives can appear anywhere on the body ([[face]], [[lips]], [[tongue]], [[throat]], and [[ears]])
*Welts may vary in size from about 5 mm to the size of a dinner plate,  typically itch severely, sting, or burn, and often have a pale border
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Candidiasis|Candidal infection]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Fungal infection]] (mycosis) of any of the ''[[Candida (genus)|Candida]]'' species, of which ''[[Candida albicans]]'' is the most common
* Candidiasis thereby encompasses infections that range from superficial, such as oral thrush and [[vaginitis]], to [[systemic]] and potentially life-threatening diseases
*Superficial infections of [[skin]] and [[mucosa]]l membranes by ''Candida'' causing local [[inflammation]] and [[Stress (medicine)|discomfort]] is common in many [[human]] populations
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Dermatitis herpetiformis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Systemic condition, usually extremely itchy. In many people the [[vesicles]] or [[papules]] appear on pressure points, such as the [[elbows]], [[knees]], [[back]] and [[buttocks]].
*[[Symptoms]] sometimes appear to be symmetrical (most prevalent at pressure points)
*It may also present as a patch of red [[skin]] with little water blisters scattered about
*The unpredictable [[skin rash]] may appear or be exacerbated by any irritation such as [[dry skin]], scratching or clothing that is rough or scratchy
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Drug eruption]]s'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Cutaneous]] [[drug eruption]]s are the most frequent type of adverse drug reactions
*Majority of these reactions are thought to be [[allergic]] in origin
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Kawasaki disease]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]]
*It also presents with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Measles]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]] with the observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]]
*Positive serologic test for serum measles IgM antibody, isolation of measles virus in culture, or detection of measles virus RNA by [[polymerase chain reaction|reverse transcription polymerase chain reaction (RT-PCR)]] is diagnostic
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rubella]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]
*''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hand foot and mouth disease]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Most commonly caused disease is the [[Coxsackie A]]
*It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]]  or above the [[tonsils]]
*Adults can also be affected and can present with
**High grade fever
**Sore throat
**Painfull Itchy rash especially on the hands/fingers and bottom of feet, several days after high temperature
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Monkeypox]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presentation is similar to [[smallpox]], although it is often a milder form
*Presents with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion.
*Within 1 to 3 days after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face (lesions usually develop through several stages before crusting and falling off)
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cytomegalovirus]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly [[asymptomatic]] , but it may present with [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]]  and [[loss of appetite]]
*Diagnostic tests are essential for the management of CMV infection in immunocompromised patients which include [[serology]], polymerase chain reaction|polymerase chain reaction (PCR), [[culture]], and [[histopathology]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acne]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s
*The upper [[arm]]s can also have [[acne]], but lesions found there are often [[keratosis pilaris]], not [[acne]]
*The typical [[acne]] lesions are [[comedones]] and [[inflammatory]] [[papules]], [[pustules]], and [[nodules]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Syphilis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]].
*[[Skin]] eruptions may be subtle and [[asymptomatic]], classically described as
**Non-pruritic bilateral symmetrical mucocutaneous [[rash]]
**Non-tender regional [[lymphadenopathy]]
**[[Condylomata lata]]
**Patchy [[alopecia]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Molluscum contagiosum]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Lesions is caused by poxvirus that results in a chronic localized infection
*Commonly flesh-colored, dome-shaped, and pearly in appearance (often 1-5 millimeters in diameter, with a dimpled center)
*Generally not painful, but they may itch or become irritated
*In about 10% of the cases, [[eczema]] develops around the lesions
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Mononucleosis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Mononucleosis]] is an acute clinical manifestation of [[EBV]]
*Initially presents with [[malaise]], [[headache]], and low-grade [[fever]]
* After progression of the disease, it may present with more specific signs of [[tonsillitis]] and/or [[pharyngitis]], cervical lymph node enlargement and tenderness, and moderate to high fever
*In most cases of infectious mononucleosis is a clinical diagnosis
**EBV serology test should be done if mononucleosis is suspected
**The laboratory hallmark of the disease is the presence of [[atypical lymphocytes]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Toxic [[erythema]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Common [[rash]] in infants, with clustered and [[vesicular]] appearance
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rat-bite fever]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple plaques
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Parvovirus B19]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*The [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Stevens-Johnson syndrome]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Symptoms]] may include [[fever]], [[sore throat]]  and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]] ([[mouth]], lips, genital, and anal)
*Mouth are usually extremely painful and reduce the patient's ability to eat or drink
*[[Conjunctivitis]] of the eyes occurs in about 30% of children
*A [[rash]] may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the [[scalp]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rocky Mountain spotted fever]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]], and [[joint pain]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Impetigo]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]].
*Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust
*Associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]]
*Diagnosis is often based on clinical manifestations
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Varicella-zoster virus]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly starts as a painful [[rash]] on one side of the face or body
*The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Scarlet fever]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]], [[headache]], and [[lymphadenopathy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningococcemia]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]], and [[vomiting]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Rickettsialpox]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*First [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab
*Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]]
*Most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Insect bite]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*The insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area,
*Often associated with formation of [[vesicles]].
 
|}
 
*Depending on the location, Pain symptoms caused by Herpes Zoster infection must be differentiated from:<ref name="pmid17143845">{{cite journal| author=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M et al.| title=Recommendations for the management of herpes zoster. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 1 | issue=  | pages= S1-26 | pmid=17143845 | doi=10.1086/510206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143845  }} </ref><ref name="pmid25231219">{{cite journal| author=Maarbjerg S, Gozalov A, Olesen J, Bendtsen L| title=Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients. | journal=Headache | year= 2014 | volume= 54 | issue= 10 | pages= 1574-82 | pmid=25231219 | doi=10.1111/head.12441 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25231219  }} </ref><ref name="pmid8545018">{{cite journal| author=Oxman MN| title=Immunization to reduce the frequency and severity of herpes zoster and its complications. | journal=Neurology | year= 1995 | volume= 45 | issue= 12 Suppl 8 | pages= S41-6 | pmid=8545018 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8545018  }} </ref>
* [[Angina]]
* [[Angina]]
* [[Cholecystitis]]
* [[Cholecystitis]]
Line 33: Line 206:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Infectious skin diseases]]
[[Category:Viral diseases]]
[[Category:Herpesviruses]]
[[Category:Infectious disease]]
{{WS}}
{{WS}}
{{WH}}
{{WH}}

Latest revision as of 22:10, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. [2]; João André Alves Silva, M.D. [3]; Sara Mehrsefat, M.D. [4]

Overview

Diagnosis of Herpes zoster might not be possible in the absence of a rash (i.e., before rash or in cases of zoster without rash). It is sometimes confused with herpes simplex, and, occasionally, with impetigo, contact dermatitis, folliculitis, scabies, insect bites, papular urticaria, candidal infection, dermatitis herpetiformis, and drug eruptions.

Differentiating Herpes Zoster from other Diseases

Skin lesions caused by Herpes Zoster infection must be differentiated from:[1][2][3][4][5][6][7][8][9]

Disease Findings
Atopic dermatitis
  • The skin of a patient with atopic dermatitis reacts abnormally to irritants such as food and environmental allergens
  • The skin on the flexural surfaces of the joints (elbows and knees) are most commonly affected regions
  • It usually present with red, flaky and very itchy skin
  • It also becomes vulnerable to surface infections caused by bacteria
Pyoderma gangrenosum
Herpes simplex
  • Primary orofacial herpes/HSV-1 presents itself as multiple, round, superficial oral ulcers
  • Genital herpes/HSV-2 can be more difficult to diagnose than oral herpes since most HSV-2-infected persons have no classical signs and symptoms
  • Adults with non-typical presentation are more difficult to diagnose. However, prodromal symptoms that occur before the appearance of herpetic lesions helps to differentiate HSV from other conditions
  • Herpes infection can recur even after successful initial treatment. The first episode is usually longer (two to four weeks) more painful and severe than the recurrent episodes
Contact dermatitis
  • Skin reaction resulting from exposure to allergens, irritants or sunlight
  • It usually presents as a localized rash or irritation of the skin only on the superficial regions of the skin
Folliculitis
Scabies
Papular urticaria
  • Skin condition, commonly caused by an allergic reaction commonly caused by direct contact with an allergenic substance, or an immune response to food, other allergen, or emotional stress
  • The rash can be triggered by quite innocent events, such as mere rubbing or exposure to cold.
  • It is characterized by raised red skin welts. Welts from hives can appear anywhere on the body (face, lips, tongue, throat, and ears)
  • Welts may vary in size from about 5 mm to the size of a dinner plate, typically itch severely, sting, or burn, and often have a pale border
Candidal infection
Dermatitis herpetiformis
  • Systemic condition, usually extremely itchy. In many people the vesicles or papules appear on pressure points, such as the elbows, knees, back and buttocks.
  • Symptoms sometimes appear to be symmetrical (most prevalent at pressure points)
  • It may also present as a patch of red skin with little water blisters scattered about
  • The unpredictable skin rash may appear or be exacerbated by any irritation such as dry skin, scratching or clothing that is rough or scratchy
Drug eruptions
Kawasaki disease
Measles
Rubella
Hand foot and mouth disease
  • Most commonly caused disease is the Coxsackie A
  • It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat or above the tonsils
  • Adults can also be affected and can present with
    • High grade fever
    • Sore throat
    • Painfull Itchy rash especially on the hands/fingers and bottom of feet, several days after high temperature
Monkeypox
  • Presentation is similar to smallpox, although it is often a milder form
  • Presents with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion.
  • Within 1 to 3 days after the appearance of fever, the patient develops a papular rash, often first on the face (lesions usually develop through several stages before crusting and falling off)
Cytomegalovirus
Acne
Syphilis
Molluscum contagiosum
  • Lesions is caused by poxvirus that results in a chronic localized infection
  • Commonly flesh-colored, dome-shaped, and pearly in appearance (often 1-5 millimeters in diameter, with a dimpled center)
  • Generally not painful, but they may itch or become irritated
  • In about 10% of the cases, eczema develops around the lesions
Mononucleosis
  • Mononucleosis is an acute clinical manifestation of EBV
  • Initially presents with malaise, headache, and low-grade fever
  • After progression of the disease, it may present with more specific signs of tonsillitis and/or pharyngitis, cervical lymph node enlargement and tenderness, and moderate to high fever
  • In most cases of infectious mononucleosis is a clinical diagnosis
    • EBV serology test should be done if mononucleosis is suspected
    • The laboratory hallmark of the disease is the presence of atypical lymphocytes
Toxic erythema
Rat-bite fever
  • Commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques
Parvovirus B19
  • The rash of fifth disease is typically described as "slapped cheeks," with erythema across the cheeks and sparing the nasolabial folds, forehead, and mouth
Stevens-Johnson syndrome
Rocky Mountain spotted fever
Impetigo
  • Commonly presents with pimple-like lesions surrounded by erythematous skin.
  • Lesions are pustules, filled with pus, which then break down over 4-6 days and form a thick crust
  • Associated with insect bites, cuts, and other forms of trauma to the skin
  • Diagnosis is often based on clinical manifestations
Varicella-zoster virus
  • Commonly starts as a painful rash on one side of the face or body
  • The rash forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks
Scarlet fever
Meningococcemia
Rickettsialpox
Insect bite
  • The insect injects formic acid, which can cause an immediate skin reaction often resulting in a rash and swelling in the injured area,
  • Often associated with formation of vesicles.

References

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  6. Dajani AS, Ferrieri P, Wannamaker LW (1972). "Natural history of impetigo. II. Etiologic agents and bacterial interactions". J Clin Invest. 51 (11): 2863–71. doi:10.1172/JCI107109. PMC 292435. PMID 4263498.
  7. CARPENTER RR, PETERSDORF RG (1962). "The clinical spectrum of bacterial meningitis". Am J Med. 33: 262–75. PMID 13876790.
  8. Bolotin D, Petronic-Rosic V (2011). "Dermatitis herpetiformis. Part I. Epidemiology, pathogenesis, and clinical presentation". J Am Acad Dermatol. 64 (6): 1017–24, quiz 1025-6. doi:10.1016/j.jaad.2010.09.777. PMID 21571167.
  9. Chen X, Anstey AV, Bugert JJ (2013). "Molluscum contagiosum virus infection". Lancet Infect Dis. 13 (10): 877–88. doi:10.1016/S1473-3099(13)70109-9. PMID 23972567.
  10. Maarbjerg S, Gozalov A, Olesen J, Bendtsen L (2014). "Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients". Headache. 54 (10): 1574–82. doi:10.1111/head.12441. PMID 25231219.
  11. Oxman MN (1995). "Immunization to reduce the frequency and severity of herpes zoster and its complications". Neurology. 45 (12 Suppl 8): S41–6. PMID 8545018.

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