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This 5-year-old girl developed redness and pain on the right side of her forehead. Later a vesicular rash developed (Figure 110-1). She was diagnosed with herpes zoster involving the first (ophthalmic) branch of the trigeminal nerve. Note the vesicles and bullae on the forehead and eyelid and the crust on the nasal tip (Hutchinson sign). Fortunately, she did not have ocular complications and her case of zoster fully healed with systemic acyclovir and acyclovir eye ointment.
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Herpes zoster is a common infection caused by varicella-zoster virus, the same virus that causes chickenpox. Reactivation of the latent virus in neurosensory ganglia produces the characteristic manifestations of herpes zoster (shingles). Herpes zoster outbreaks may be precipitated by aging, poor nutrition, immunocompromised status (Figures 110-2 to 110-4), physical or emotional stress, and excessive fatigue. Although zoster most commonly involves the thoracic and lumbar dermatomes, reactivation of the latent virus in the trigeminal ganglia may result in herpes zoster ophthalmicus (HZO) (Figures 110-1 to 110-5).
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