--- title: 83-year-old man presents to you with new-onset vesicular rash description: It's Vesicular Rash Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/Blog%20Covers/Blog%20-%2083-year-old%20man%20presents%20to%20you%20with%20new-onset%20vesicular%20rash.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/83-year-old-man-presents-to-you-with-new-onset-vesicular-rash#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) family medicine # 83-year-old man presents to you with new-onset vesicular rash It's Vesicular Rash Quiz Time with Med-Challenger! [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Dec 17, 2025 [family medicine](https://challengercme.com/blog/tag/family-medicine) [Personal Education](https://challengercme.com/blog/tag/personal-education) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) ABFM Exam Prep + CME Med-Challenger Family Medicine Pass-guaranteed ABFM exam review with CME built-in. Try it for free. On sale now. [START FM REVIEW](https://fuse.challengercme.com/fulltrial/198) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/83-year-old-man-presents-to-you-with-new-onset-vesicular-rash&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/83-year-old-man-presents-to-you-with-new-onset-vesicular-rash&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/83-year-old-man-presents-to-you-with-new-onset-vesicular-rash&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/83-year-old-man-presents-to-you-with-new-onset-vesicular-rash&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![vesicular rash](https://challengercme.com/hubfs/Blog%20Covers/Blog%20-%2083-year-old%20man%20presents%20to%20you%20with%20new-onset%20vesicular%20rash.png) An 83-year-old man presents to you with new-onset vesicular rash around the right upper quadrant of his face that he tells you is very painful (see image). ![Rash](https://challengercme.com/hs-fs/hubfs/image%20(25).png?width=400&height=270&name=image%20(25).png) On examination, you note that the rash also appears on the tip of his nose. What is the significance of this finding? - About one-third of patients with this finding will also develop oral lesions. - This finding is a strong predictor of immunosuppression and disseminated vascular disease. - This finding doubles the patient’s risk of developing chronic ocular inflammation with possible vision loss. - This finding is an independent predictor for the presence of an autoimmune disorder. - This finding should prompt a thorough examination of the ear. The correct answer is: This finding doubles the patient’s risk of developing chronic ocular inflammation with possible vision loss.   This patient’s presentation is most consistent with herpes zoster (shingles), which is due to reactivation of latent *Varicella* infection. The lifetime risk of any reactivation (anywhere in the body) is about 10% to 20%. About 1 in 3 Americans will develop shingles in their lifetime. The risk increases with age, as does the risk of postherpetic neuralgia. This risk is increased in people aged 50 years or older, and 10% to 25% of these cases specifically involve the ophthalmic division of the trigeminal nerve (herpes zoster ophthalmicus). Despite its name, only one-third of patients with herpes zoster ophthalmicus will have ocular involvement (conjunctivitis, keratitis, uveitis), which can lead to blindness, corneal denervation, and chronic ocular inflammation. Among patients with herpes zoster ophthalmicus, some will also have a herpes lesion on the tip of their nose. This signifies an involvement of the nasociliary branch (innervates the tip of the nose) and is known as a Hutchinson sign. Patients with herpes zoster ophthalmicus and a Hutchinson sign have twice the incidence of ocular involvement as those without a Hutchinson sign. Permanent sequelae of ophthalmic zoster infection with eye involvement may include chronic ocular inflammation, loss of vision, and debilitating pain. Antiviral medications, such as acyclovir, valacyclovir, and famciclovir, are the mainstay of therapy and are most effective in preventing ocular involvement when started within 72 hours after the onset of rash. Famciclovir and valacyclovir have fewer adverse events and offer a more convenient dosing schedule than acyclovir. Timely diagnosis and management of herpes zoster ophthalmicus, with referral to an ophthalmologist when ophthalmic involvement is present, are critical in limiting visual morbidity. Hutchinson sign is not associated with oral lesions and is not an independent predictor of autoimmune disorders. Ramsay Hunt syndrome (herpes zoster oticus) occurs when a shingles infection affects the facial nerve near an ear. In addition to a painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear. Hutchinson sign is not associated with herpes zoster oticus, thus a specialized ear examination is not necessary in patients with Hutchinson sign. **References:** Bell A. Herpes zoster and postherpetic neuralgia: prevention and management. *Am Fam Physician.* 2011;83(12):1432-1437. Carlislie R. Differential diagnosis of a swollen red eyelid. *Am Fam Physician.* 2015;92(2):106-112. Haile-Mariam T, May L. Viral illnesses. In: Marx JA, et al, eds. *Rosen’s Emergency Medicine: Concepts and Clinical Practice.* 8th ed., 2014:1718-1741. Johnson JL, Amzat R, Martin N. Herpes zoster ophthalmicus. *Prim Care*. 2015;42(3):285-303.   This question appears in [Med-Challenger Family Medicine Exam Review with CME](https://challengercme.com/family-medicine-exam-review-cme-course) [Try for free and save](https://fuse.challengercme.com/fulltrial/198). Ace your exams and meet your CME/MOC requirements for just $35 a month! [![subcription_icon_fm-e1519157340449-Feb-09-2023-06-23-09-6746-PM](https://challengercme.com/hs-fs/hubfs/Imported_Blog_Media/subcription_icon_fm-e1519157340449-Feb-09-2023-06-23-09-6746-PM.png?width=250&height=256&name=subcription_icon_fm-e1519157340449-Feb-09-2023-06-23-09-6746-PM.png)](https://challengercme.com/family-medicine-exam-review-cme-course) [![QuizButton-1](https://challengercme.com/hs-fs/hubfs/QuizButton-1.jpg?width=235&height=81&name=QuizButton-1.jpg)](https://challengercme.com/blog/lumbar-puncture-on-a-patient-with-suspected-meningitis) --- No matter your program, no matter the size, [Med-Challenger for Groups and Institutions](https://challengercme.com/institutional-medical-education-for-groups) can better prepare your program or group, fulfill industry requirements, and increase test scores.   For personal medical education that includes board's prep, MOC, and CME requirements, Med-Challenger has you covered in [Family Medicine](https://challengercme.com/family-medicine-exam-review-cme-courses), [Emergency Medicine](https://challengercme.com/emergency-medicine-exam-review-cme-courses), [Internal Medicine](https://challengercme.com/internal-medicine-exam-review-cme-courses), [Pediatrics](https://challengercme.com/pediatric-medicine-exam-review-cme-courses), [Pediatric Emergency Medicine](https://challengercme.com/category-pediatric-emergency-medicine-courses), [OBGYN](https://challengercme.com/obgyn-exam-review-cme-courses), [Physician Assistants](https://challengercme.com/physician-assistant-exam-review-cme-courses), and [Nurse Practitioners.](https://challengercme.com/nurse-practitioner-exam-review-cme-courses)   Never miss a thing. Subscribe to our blog and save! [![SUBSCRIBE Medical Education Blog & Newsletter](https://no-cache.hubspot.com/cta/default/9106197/703c79e6-b750-4dfa-acfa-b6ca5307c563.png)](https://cta-redirect.hubspot.com/cta/redirect/9106197/703c79e6-b750-4dfa-acfa-b6ca5307c563)   ## Similar posts quick quiz ### [48-year-old man presents to you complaining of palpitations](https://challengercme.com/blog/48-year-old-man-presents-to-you-complaining-of-palpitations) It's Palpitations Quiz Time with Med-Challenger! Med-Challenger Dec 14, 2024 internal medicine ### [38-year-old man with a history of alcohol abuse presents to you with symptoms of sinusitis](https://challengercme.com/blog/38-year-old-man-with-a-history-of-alcohol-abuse-presents-to-you-with-symptoms-of-sinusitis) It's CNS Infection Quiz Time with Med-Challenger! Med-Challenger Dec 30, 2024 quick quiz ### [A 12-year-old boy presents to you with abdominal pain](https://challengercme.com/blog/a-12-year-old-boy-presents-to-you-with-abdominal-pain) It's Abdominal Pain Quiz Time with Med-Challenger! Med-Challenger Feb 9, 2025 ## Stay informed. ### Subscribe to our [Medical Education Blog](https://challengercme.com/blog)  Stay informed of new medical education content, certification requirements and deadlines, case-based CME quizzes, and special offers. [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com) #### **Online Medical Education** 1-800-676-0822 Sales - Option 1 Support - Option 2   ### Company - [Get Support](https://support.challengercme.com/knowledge/kb-tickets/new) - [Policies](https://support.challengercme.com/knowledge) - [Special Offers](https://challengercme.com/special) ### Products - [Exam Prep & CME](https://challengercme.com/med-challenger-free-trial-landing-page) - [Institutional LMS](https://challengercme.com/atlas-pro-inst) ### Resources - [CME Blog](https://challengercme.com/blog) - [Knowledge Base](https://support.challengercme.com/knowledge) ### Account - [Create Account](https://fuse.challengercme.com/sign-up) - [Login](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) © 2026 Challenger Corporation. All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "herpes zoster (shingles)", "herpes zoster ophthalmicus", "Hutchinson sign", "nasociliary branch of trigeminal nerve", "ocular involvement and chronic ocular inflammation", "antiviral therapy (acyclovir, valacyclovir, famciclovir)", "postherpetic neuralgia", "Ramsay Hunt syndrome", "medical education", "exam preparation" ], "articleSection" : "Family Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-12-13T20:20:26.184Z", "datePublished" : "2024-12-13T20:20:25.000Z", "description" : "It's Vesicular Rash Quiz Time with Med-Challenger!", "headline" : "83-year-old man presents to you with new-onset vesicular rash", "image" : [ { "@type" : "ImageObject", "description" : "Challenger Corporation logo", "url" : "https://challengercme.com/logo.png" } ], "inLanguage" : "en-US", "keywords" : [ "shingles", "herpes zoster", "Hutchinson sign", "herpes zoster ophthalmicus", "nasociliary", "ophthalmic division", "trigeminal nerve", "ocular involvement", "acyclovir", "valacyclovir", "famciclovir", "postherpetic neuralgia", "Ramsay Hunt", "Family Medicine", "exam prep", "Med-Challenger", "medical education" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/83-year-old-man-presents-to-you-with-new-onset-vesicular-rash", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "A vesicular lesion on the tip of the nose represents Hutchinson sign, indicating involvement of the nasociliary branch of the trigeminal nerve. According to the article, this sign is associated with a higher likelihood of ocular involvement in herpes zoster ophthalmicus and doubles the patient’s risk of developing chronic ocular inflammation with possible vision loss. Prompt antiviral therapy and ophthalmology referral when eye involvement is present are emphasized in the article." }, "name" : "What is the significance of a vesicular lesion on the tip of the nose in a patient with shingles?", "text" : "An 83-year-old man presents with a painful vesicular rash around the right upper quadrant of his face and a vesicular lesion on the tip of his nose. What is the significance of this finding?" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "A vesicular lesion on the tip of the nose that signifies involvement of the nasociliary branch in herpes zoster ophthalmicus." }, "name" : "What is Hutchinson sign?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Patients with Hutchinson sign have about twice the incidence of ocular involvement and an increased risk of chronic ocular inflammation and possible vision loss, per the article." }, "name" : "How does Hutchinson sign affect the risk of ocular involvement?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Antiviral medications (acyclovir, valacyclovir, famciclovir) are most effective at preventing ocular involvement when started within 72 hours after rash onset." }, "name" : "When are antiviral medications most effective at preventing ocular involvement?" }, "position" : 3 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Valacyclovir and famciclovir are noted in the article as having fewer adverse events and a more convenient dosing schedule than acyclovir." }, "name" : "Which antivirals are noted to have fewer adverse events and more convenient dosing?" }, "position" : 4 } ], "name" : "Practice Questions", "numberOfItems" : 4 } ```