These lesions develop in a dermatomal distribution
(thoracic and lumbar dermatomes are most common).
The clinical manifestations of HZ are usually distinctive and characterized by painful vesicular rash appearing in a unilateral, dermatomal distribution
. Disseminated lesions, visceral involvement or atypical clinical presentation may occur in imunocompromised host.
Out of the total number of 100 patients 89% of the patients had grouped vesicles, 79% had grouped papules and vesicles which were present in dermatomal distribution
. This is in conformity with the study of Chaudhary et al, (5) who also noted the majority of the patients with erythematous papules and vesicles.
The straight leg rising (SLR) test is commonly positive in a dermatomal distribution
among recently diagnosed sciatica.
(8) Herpes zoster is heralded by a sensation of tingling and burning in a unilateral dermatomal distribution
accompanied by fever, chills, headache, stomachache, and/or malaise.
Physical examination demonstrated purple-black tender toes, bluish feet, cold up to both knees and decreased sensation to touch bilaterally without dermatomal distribution
. Mild trophic changes to the digits were observed.
Herpes zoster is a common disease of the dorsal root ganglia and sensory nerve fibers clinically characterized by unilateral painful vesicular eruption of the skin in a dermatomal distribution
. Segmental motor weakness is a rare complication that occurs in 0-5 percent of patients and is associated with an excellent prognosis for recovery.
% Male 44 54.32 42 51.85 Female 37 45.67 39 48.14 Total 81 100 81 100 Table 4: Dermatomal distribution
in both the groups Distribution Valacyclovir Famcyclovir Thoracic 33 (40%) 30(37%) Cervical 16(20%) 19(23%) Trigeminal 20(25%) 19(23%) Lumbar 12(15%) 13(17%) Table 5 Variables Full Crusting Healing Loss of Pain V F V F V F Mean 9.73 10.43 20.32 20.66 21.03 22.15 Sd 1.85 1.71 1.61 1.87 1.84 1.97 P< 0.00216 0.1933 0.00014 Table 6 Variables Full Crusting Healing Loss of Pain V F V F V F Mean 13.75 12.8 22.5 22.6 23.5 24.6 Sd 0.46291 0.83666 1.414214 0.83666 0.46291 1.516575
A dermatomal distribution
would suggest herpes zoster.
A high index of suspicion for HZ is warranted in any patient presenting with a painful postoperative rash in a dermatomal distribution
relevant to the site of surgery.
In temperate climates, this highly contagious virus has a seasonal prevalence in winter and spring. Chickenpox is associated with a widespread vesicular exanthema that occurs without respect to dermatomal distribution
(Figure 1) and has been well recognized by parents and pediatricians alike for more than 100 years.