Hepatoadrenal necrosis and encephalitis. Occurs on distal portion of fingers. Reactivation of latent virus present in the sensory ganglia. Classic description is that of grouped vesicles on an erythematous base in one dermatome. Thoracic nerve dermatomes are most commonly involved followed by the major branches of the trigeminal nerve.
Symptoms are pain, dysethesia, and pruritus.
Healing requires 2 to 3 weeks, and the afflicted persons are infectious until the lesions have crusted over. Persons of any age can be affected, but the disease is more common and more severe in the elderly. Diagnosis is by clinical presentation, though Tzanck smear, biopsy, and viral culture may be performed. Acyclovir is very effective for pain relief. Alternatively, famciclovir 500 mg PO TID for 7 days can be used and may be more effective at preventing postherpetic neuralgia.