Image Challenge – February 26th

Question: What eponymous abnormal finding is noted in this picture, and what should your next step be in management of this condition?

Answer: This is Hutchinson’s sign, or an eruption of vesicles on the tip of the nose due to herpes zoster. This should prompt you to initiate acyclovir treatment and seek an urgent referral to ophthalmology for evaluation of ophthalmic zoster. Hutchinson’s sign occurs because the virus reactivates along the nasal branch of the nasociliary nerve (a branch of a branch of the trigeminal nerve.

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