Clinical Cases in Scalp Disorders by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030934262
Publisher: Springer International Publishing

Based on the case description and the photographs, what is your diagnosis?

Differential Diagnoses

1.

Herpes gladiatorum.

2.

Contact dermatitis.

3.

Herpes zoster.

4.

Basal cell carcinoma.

Diagnosis

Herpes zoster.

Discussion

Chickenpox and herpes zoster are caused by varicella zoster virus (VZV). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. After the primary infection, the virus lies dormant in the nerves, including the cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia. Herpes zoster is the result of reactivation of latent VZV. The disease most frequently occurs in older adults. It presents as painful, unilateral dermatomal, vesicular lesions on the erythematous background that do not cross the midline [1]. Crusts can be also presented. The most common locations are the thoracic nerves and the ophthalmic division of the trigeminal nerve with possible eye involvement (keratitis, scarring, and vision loss). The major complication of herpes zoster is an post-herpetic neuralgia, defined as a pain persisting for more than 90 days after the resolution of the skin lesions [2]. The diagnosis on herpes zoster is established based on the clinical picture. Polymerase chain reaction, direct fluorescent antigen testing or viral culture are rarely performed [3]. Antiviral drugs (acyclovir, famciclovir, and valacyclovir) should be considered for all patients with herpes zoster and they are especially recommended for patients older than 50 years, those who have a moderate or severe pain or rash, and those with involvement of non-truncal dermatomes [2].

Differential diagnoses for the presented patient included herpes gladiatorum, contact dermatitis and basal cell carcinoma.

Herpes gladiatorum is a skin infection caused by herpes simplex virus type 1. The disease is spread through direct skin-to-skin contact, thus it is more commonly observed in individuals who play sport with the close contact [4]. Clinically, herpes gladiatorum is characterized by the presence of cluster or clusters of clear, fluid-filled vesicles with surrounding erythema. Each body area can be affected. Pain may be reported [4]. The lesions can be multiple and are not limited to one dermatome. Fever and enlarged lymph nodes are rarely reported [4].

Contact dermatitis is an inflammatory eczematous skin disease. The disease is rarely presented on the scalp area, because of the great thickness of the epidermis in this region. In the case of application of irritants or allergens on the scalp symptoms are usually observed on the face or neck. Clinically, contact dermatitis presents as an erythema with scaling and coexisted itch [5]. In acute disease, vesicles or pustules may be presented [5].

Basal cell carcinoma is the most common skin malignancy. The incidence rate of the disease increases with age. Basal cell carcinoma presents as a tiny, hardly visible papule, growing into a nodule or a plaque that is sometimes ulcerated. The face, scalp and neck are most commonly affected [6].

In the presented patient, based on the clinical manifestation the diagnosis of herpes zoster involving ophthalmic branch (V1) of the trigeminal nerve was established. She was treated with 500 mg intravenous acyclovir three times daily per 10 days and oral paracetamol in order to reduce pain. A complete resolution of skin lesions was observed.

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