A patient with zoster-involving V1, the ophthalmic division of the trigeminal nerve, should be immediately referred to an ophthalmologist due to the risk of corneal ulceration. Signs or symptoms of this condition such as painful vesicular lesions on the tip of the nose or lid margins should be considered an ocular emergency. A significant number of people with HIV disease may also develop Herpes meningoencephalitis secondary to disseminated zoster. Neurological symptoms should be sought and a mental status exam should be included in the neurological exam of patients presenting with shingles. If present, a neurological consultation with a lumbar puncture is imperative, and intravenous acyclovir is indicated.
Neglected infections can progress to ecthyma.
Like molluscum, staphylococcus bacteria can be spread by shaving and are highly contagious from person to person. The causative agent, Bartonella henslae, can be observed upon biopsy. Nodular melanoma may also need to be considered in the differential diagnosis. Bibliography Ansary MA, Hira SK, Bayley AC, et al. A Colour Atlas of AIDS in the Tropics.