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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Rashes on skin. Shingles suspected. Improved after treated with Bactrim, Augmentin, Prednisone, and Bactroban. Definitive diagnosis?

Hi. My husband thought he had been bitten by a mosquito on the top of head on Oct 2, 2013. On Oct. 7, he developed a red, weeping rash on the right side of his forehead. He had some rash on the left side. The rash also was present on the right side of his face and over his truck, genitalia, and back. His forehead, bridge of his nose, and both eyelids became extremely edematous with edema sacs in the inner corners of both eyes. Initial diagnois: Shingles at an urgent care center. By the next day, the diagnosis was a spider bite, and the venom was causing a systemic reaction. Now, 12 days after the initial concern, the diagnosis is Shingles. He has been treated with Bactrim, Augmentin, Prednisone, and Bactroban topically. He is definately improved. He does not complain of pain, but initially had slight burning and itching. He has 4 black areas on the top of his head, and the area on his forehead has turned black. Is there a way to get a definitive diagnosis at this late date?
Thu, 14 Nov 2013
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Dermatologist 's  Response
hi. Seems like insect bite hypersensitivity based on the distribution of the rash (forehead, trunk, genitalia and back). Shingles does nt such have a widespread distribution like this unless it is disseminated Zoster which happens only in the immunocompromised. Shingles usually involves 1 or 2 dermatomes in an area.

Another thing which favors the diagnosis of Insect bite hypersensitivity is the improvement on prednisone. If it was shingles it would have spread further!! So its most likely insect bite reaction. I think you should apply a steroid+antibiotic combination cream twice daily rather than just bactroban topically
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