Mahmoud Farhoud, MD Jennifer C. Thompson, MD Orlando Veterans Affairs Medical Center, Fla (Drs. Farhoud and Thompson); University of Central Florida College of Medicine, Orlando (Dr. Farhoud) firstname.lastname@example.org
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
The authors reported no potential conflict of interest relevant to this article.
Not only was the rash on this patient’s face and scalp painful, but he had a burning feeling—with vision problems—in his right eye, too.
A 58-year-old man sought care at our clinic for burning in his right eye and a skin eruption on his right forehead and scalp. The pain in both had been getting progressively worse over the previous 10 days. The patient also reported that he had decreased vision in his right eye, as well as a fever, chills, photophobia, and headache. He had a history of psoriasis, which was being treated with adalimumab and methotrexate.
A physical exam revealed vesicles on an erythematous base on his right scalp, forehead, upper and lower eyelids, dorsum of his nose, and cheek (FIGURE). The distribution of the vesicles corresponded to the ophthalmic branch of the trigeminal nerve.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?