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Dermatology/Raised Cluster of Red Spots on skin

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Spot on Back
Spot on Back  

spot on abdomen
spot on abdomen  
Hello Dr. Fisher,

I have two spots on my body that I am hoping you can help me with.  One spot is on my lower left back, the other spot is on my lower left abdomen.  

The spot on my back has been there about 3 days and has not gotten worse, but has not improved.  It does not itch, but does burn a bit when touched or brushed with clothing.  It does not feel warm to the touch and is not tender.  It is about the size of a quarter.

The spot on my abdomen has been there about 2 days and has worsened since yesterday.  This spot itches and burns a little, but not as much as the spot on my back.  It is not tender nor warm to the touch.  It is about the size of a half-dollar.

I have been using some antifungal and cortisone cream for about 24 hours with no real improvement.

I also am having some areas on my left side, left back, and left abdomen that burn slightly when brushed with my hand or clothing, but do not hurt when not touched.  These spots have no rash or anything associated with them and are not tender at all, just burn (sort of like a sunburn) when touched.  There are about 4 or 5 different locations.  This symptom started about a week ago before the two spots showed up.  

I have attached photos below.

Any ideas?

Thanks!!!

Answer
Shingles (herpes zoster) is a painful, blistering skin rash due to the varicella-zoster virus, the virus that causes chickenpox.
See your doctor ASAP for Valtrex-1gram three times a day for 7 days.

Causes, incidence, and risk factors

After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves years later.

The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.

Shingles may develop in any age group, but you are more likely to develop the condition if:

You are older than 60
You had chickenpox before age 1
Your immune system is weakened by medications or disease
If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or a chickenpox vaccine, they can develop chickenpox, not shingles.

Symptoms

The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe and is usually present before any rash appears.

Red patches on the skin, followed by small blisters, form in most people.

The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.
The rash usually involves a narrow area from the spine around to the front of the belly area or chest.
The rash may involve the face, eyes, mouth, and ears.
Other symptoms may include:

Abdominal pain
Fever and chills
General ill feeling
Genital sores
Headache
Joint pain
Swollen glands (lymph nodes)
You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include:

Difficulty moving some of the muscles in the face
Drooping eyelid (ptosis)
Hearing loss
Loss of eye motion
Taste problems
Vision problems
Signs and tests

Your health care provider can make the diagnosis by looking at your skin and asking questions about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles.

Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus, but they cannot confirm that the rash is due to shingles.

Treatment

Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used.

The medications should be started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The drugs are usually given in pill form, and in high doses. Some people may need to receive the medicine through a vein (by IV).

Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These drugs do not work in all patients.

Other medicines may include:

Antihistamines to reduce itching (taken by mouth or applied to the skin)
Pain medicines
Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia
Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort.
Valtrex is the treatment of choice

Resting in bed until the fever goes down is recommended.

Keep the skin clean.
Do not reuse contaminated items.
Wash nondisposable items in boiling water or disinfect them before using them again
You may need to stay away from people while the sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women.

Expectations (prognosis)

Herpes zoster usually clears up in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.

Sometimes, the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia.

Postherpetic neuralgia is more likely to occur in people over age 60. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe.

Complications

Complications may include:

Another attack of shingles
Bacterial skin infections
Blindness (if shingles occurs in the eye)
Deafness
Infection, including encephalitis or sepsis (blood infection) in persons with a weakened immune system
Ramsay Hunt syndrome if shingles affects the nerves in the face
Calling your health care provider

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

Prevention

Avoid touching the rash and blisters on persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.

The United States Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 60 receive the herpes zoster vaccine as part of routine medical care.

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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