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57-Year-Old Female With 2-Day History of Sore Bumps on Trunk, Lateral to Left Breast

Can you diagnose this case?

Kaplan DL. Consultant. 2018

Signs and Symptoms

This 57-year-old woman presented with a 2-day history of sore bumps on the trunk, lateral to the left breast. She denied any recent exposure history, but she recently had been doing yard work. She was otherwise healthy.

What are these painful papules?

Choose one to reveal diagnosis and discussion

Miliaria (heat rash)
Staphylococcus folliculitis
Shaving folliculitis
Herpes zoster
Insect bite reaction

Answer: Herpes zoster

See the full case at Consultant360

This patient had the classic grouped papules (soon to be vesicles) in a dermatomal distribution and associated with pain that support the diagnosis of herpes zoster.

Miliaria are usually minute, discrete, nonfollicular lesions found in sweaty areas under occlusion; they are most commonly seen in humid climates but usually are not tender. Staphylococcal and shaving folliculitis can be tender but develop around a follicle, unlike what is seen in this woman’s case. Insect bites are typically pruritic, unlike in this case.

The patient responded to appropriate antiviral therapy without any postherpetic sequelae, given that the outbreak was diagnosed and treated early and given her relatively young age at onset.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.