Characteristics of patients with shingles admitted to a district general hospital

Herpes Zoster Presentation, Management, and Prevention: A Modern Case-Based Review

Herpes zoster (HZ) is a common cutaneous entity with protean clinical presentations, management options, complication rates, and prevention strategies, all of which are rife with dogma. During an inpatient consultation for HZ, have you ever been approached by a frantic staff or family member, worried that a pregnant, elderly, or infant contact will be 'infected' if they get too close? Have your patients ever asked you about their risk of having HZ twice, or claimed that they have frequent 'recurrences'? In what timeline should antiviral therapy be employed? Is there evidence for prednisone or gabapentin in acute HZ treatment? Who should be vaccinated against HZ and what are the benefits and risks? In case-based form, these and other complex but common scenarios will be examined using clinical and viral mechanistic clues, along with updated treatment and prevention guidelines, to provide a modern HZ case management compendium, comprehensive of the diverse age and health populations now presenting with this condition.

Skin and breast disease in the differential diagnosis of chest pain

There are several skin and breast lesions that can cause pain or tenderness. In most cases the presence of a skin lesion, if not its definitive diagnosis, will be clinically evident. In most instances treatment of these painful skin lesions is by simple excision, which will also provide histologic confirmation of the diagnosis. It would be rare for a cutaneous cause of skin pain to be mistaken for another cause. The prodromal pain of herpes zoster is most likely to cause diagnostic confusion. The painful skin lesions are usually identified by the patient as being the source of their discomfort. The specific diagnosis may not be apparent without submission of lesional tissue for histology. Chest pain is an uncommon presenting symptom of benign and malignant breast lesions. Breast examination and investigation may be appropriate when other causes of chest pain are not evident.