Herpes Zoster That Resembles "Athlete’s Foot"

 

When vesicles developed on a 35-year-old man’s right sole, he thought he was having a recurrence of "athlete’s foot." However, pain and tenderness in the area suggested herpes zoster. Indeed, the vesicles and erosions shown are mainly in the S1 dermatome.

The diagnosis of herpes can be (and was) confirmed by the presence of multinucleated giant cells in a Tzanck smear taken from the floor of a vesicle. Cytology cannot distinguish between herpes simplex and herpes zoster; however, viral culture of vesicle fluid can make this determination. The pain and rash disappeared promptly following oral acyclovir therapy.

Zoster is most commonly seen in elderly persons. If it appears in a young person, evaluation for possible causes of immunosuppression is indicated; zoster can be the first sign of HIV infection. No underlying immunosuppressive disease was found in this patient.