Shingles
Presentation
- Can occur at any age in patients who have had varicella
- Vesicular eruption affecting whole or part of a single dermatome
- Pain often precedes rash formation
- Pain may last long after rash clears (post-herpetic neuralgia)
- Further episodes may occur
- In those who are not immune, varicella may develop after contact with shingles
Management
- In young, fit patients, analgesia may be all that is required
- Antiviral treatment, such as aciclovir, can be helpful
Bullous pemphigoid
Presentation
- Usually occurs in the elderly
- Blisters are tense and may be blood filled
- Often affects flexures
- Oral blisters may occur but are rare
- Patients usually otherwise well
- Nikolsky's sign (when rubbing results in exfoliation of top layer of skin) is negative
Management
- Treatment includes oral steroids and immunosuppressant drugs
- Dose can often be reduced quite quickly
- Usually settles with time and treatment can be stopped
Bullous pemphigus
Presentation
- Usually occurs in middle age
- Affects trunk, flexures and scalp
- Occurs in those with otherwise poor health
- May be associated with malignancy, including undiagnosed tumours
- Blisters are superficial and flaccid
- Severe, often life-threatening condition
- Nikolsky's sign is positive
Management
- Treatment includes oral steroids and immunosuppressant drugs
- Treatment can be difficult
- Treatment is usually very prolonged
Insect bite
Presentation
- Single or multiple vesicles, usually in a cluster
- Often intensely itchy
- Urticaria may precede appearance of the vesicle
- If recurrent, insect repellents may decrease risk of further bites
Management
- Oral or topical antihistamines will decrease itching
- Secondary bacterial infection may occur
- In more severe cases, topical or oral steroids can be helpful
- Rarely, anaphylaxis may develop (especially to wasp stings)
Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary.
