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| Fig. 25.4 Grouped vesicles on an erythematous base in a dermatomal distribution. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
Lesions of herpes zoster involving the tip, side, or root of the nose indicate involvement of the nasociliary branch of the first division of the trigeminal nerve. This is known as Hutchinson’s sign and should alert you to the possibility of herpes zoster ophthalmicus (see Fig. 25-4). Ocular disease occurs in 20% to 70% of patients with ophthalmic zoster, and antiviral therapy as well as ophthalmologic evaluation is routinely recommended. The triad of herpes zoster with cutaneous involvement of the auditory canal and auricle, ipsilateral facial palsy, and excruciating ear pain is known as the Ramsay Hunt syndrome and is the result of viral reactivation within the geniculate ganglion.
