Herpes Zoster: The Daily PANCE Blueprint
A 68-year-old woman has three days of burning pain followed by a rash on the left side of her back. On exam there are grouped vesicles on an erythematous base in a single band that stops abruptly at the midline, following one dermatome. She is otherwise well, and the rash does not involve her face or eyes. Which of the following is the most appropriate treatment?
A. Oral valacyclovir
B. Oral prednisone alone
C. Topical mupirocin
D. Reassurance; no treatment is helpful this late
E. Oral acyclovir only if the rash spreads
Answer and topic summary
The answer is A. Oral valacyclovir
A painful, grouped vesicular rash in a single dermatome that stops at the midline is herpes zoster (shingles) — reactivation of latent varicella-zoster virus in a sensory ganglion. The treatment is an oral antiviral — valacyclovir, famciclovir, or acyclovir — and it works best started within 72 hours of rash onset, which this patient is still within; it speeds healing and reduces the risk of postherpetic neuralgia. The traps: it is not “too late” at day 3; corticosteroids alone do not treat the virus (only a selected add-on, never monotherapy); mupirocin treats bacterial impetigo, not a viral eruption; and waiting for spread squanders the window. Always check for eye involvement (zoster ophthalmicus) — that is an emergency.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
