Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

708 Herpes Zoster Hidradenitis Suppurativa

differential diagnosis

■Herpes simplex can simulate zoster in rare patients.

■Insect bites

■Cellulitis

management

What to Do First

■Assess the timing of the eruption, as intervention with therapy is

effective only in patients with early diagnosis (∼72 hours).

■Assess whether the patient is immunosuppressed.

➣Consider testing for HIV infection.

General Measures

■Pain management

■Local soaks

■Although this is an infection, it is spread only by contact with vesicles

and for people who are naive to the virus (non-immunized or not

previously infected with varicella).

specific therapy

■Valacyclovir 1000 mg tid for 10 days (contraindicated in patients who

are immunosuppressed)

■Famciclovir 500 mg tid for 7 days

■Acyclovir 800 mg five times per day for 5–7 days

■Oral prednisone has been advocated by some in conjunction with

antiviral therapy in a 2-week tapering dose (60 to 0 mg).

follow-up

■Persistent pain is a problem, and its likelihood correlates with the

age of the patient.

complications and prognosis

■Post-herpetic neuralgia

■Secondary infection

Hidradenitis Suppurativa..............................

JEFFREY P. CALLEN, MD

history & physical

History

■Tender, red lesions that may drain serosangineous or suppurative

material in the axilla, genital, perianal areas and under breasts