An elderly patient presents with unilateral pain and a vesicular itchy rash on the face. The most likely diagnosis is?

An elderly patient presents with unilateral pain and a vesicular itchy rash on the face. The most likely diagnosis is?

• A. Herpes Zoster (Shingles)
• B. Varicella (Chickenpox)
• C. Herpes Simplex Type 1 infection
• D. Impetigo

Answer: (A)

Unilateral, painful vesicular eruption along a facial distribution in an older adult is classic for reactivation of varicella-zoster virus (shingles). After the primary chickenpox infection, the virus remains dormant in nerve ganglia and can reactivate later, causing a neuritic pain that often precedes a band-like group of vesicles confined to a single dermatomal area. On the face, this can involve the trigeminal nerve, producing vesicles on one side in a dermatomal pattern. This dermatomal, painful, vesicular rash is why herpes zoster is the most likely diagnosis here. Chickenpox would typically present as a widespread vesicular rash in multiple stages and is more common in children. HSV-1 infection usually causes localized cold sores around the mouth and does not follow a single dermatomal band. Impetigo presents with honey-colored crusts rather than a unilateral vesicular vesicle band and lacks the characteristic dermatomal distribution and neuropathic pain.

Unilateral, painful vesicular eruption along a facial distribution in an older adult is classic for reactivation of varicella-zoster virus (shingles). After the primary chickenpox infection, the virus remains dormant in nerve ganglia and can reactivate later, causing a neuritic pain that often precedes a band-like group of vesicles confined to a single dermatomal area. On the face, this can involve the trigeminal nerve, producing vesicles on one side in a dermatomal pattern. This dermatomal, painful, vesicular rash is why herpes zoster is the most likely diagnosis here.

Chickenpox would typically present as a widespread vesicular rash in multiple stages and is more common in children. HSV-1 infection usually causes localized cold sores around the mouth and does not follow a single dermatomal band. Impetigo presents with honey-colored crusts rather than a unilateral vesicular vesicle band and lacks the characteristic dermatomal distribution and neuropathic pain.