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A very painful skin rash…#2

Lesions description

This is a vesicular and crusted rash with few pustules. We can describe an irregular contour of the rash on erythematous mucosa localised around the left nasolabial fold and left nostril.

Diagnostic

Left maxillary zoster (V2 nerve) secondary to hyaluronic acid injections.

Located complications already there

Secondary impetinization (staphylococcus aureus surinfection) probably due to itching. Many staphylococcus aureus are found in the nostril area as zoster is associated to these itchy lesions.

Potential complications to be considered

Each patient with a small vesicle located on the nostril of zoster ophthalmic complication.

Things to do

  • No exams needed.
  • Treatments :
    • Local antiseptic
    • Cutting and brushing nails (impetinization prevention)
    • Analgesic level 1 or 2
    • Local antibiotic therapy (fucidine)
    • No antiviral therapy Valaciclovir per-os (10mg/kg) if she consults after 72 hours since first signs; however antiviral therapy is indicated in case of immunosuppression or ophthalmologic complication.
    • Some gives it systematically for post zoster pains warning.
    • No kidney failure: dosage adaptation is not necessary.

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