QJM: An International Journal of Medicine, 2018, 483
doi: 10.1093/qjmed/hcy011
CLINICAL PICTURE
Herpes zoster and Hutchinson’s sign
A 34-year-old woman presented with a 2-day history of painful
skin rash with blisters on the right side of her face. She had a
history of receiving treatment with infliximab for ulcerative col-
itis for 2 years. Erythema and edema was noted over the right
face, including the cheek, upper eyelid and forehead (Figure 1).
Multiple crusted blisters were found on the right face, including
the tip of the nose (Figure 1, arrow). This finding was consistent
with Hutchinson’s sign. The patient was ultimately diagnosed
Figure 1. This picture showed patient with herpes zoster along the right oph-
thalmic and maxillary division of the trigeminal nerve, and a crusted blister was
found on the tip of the nose.
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Clinical picture
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with herpes zoster and was initially treated with intravenous
antiviral medication, steroids and antipyretic analgesics.
Similar to other herpes viruses, varicella zoster virus (VZV)
causes primary and recurrent infections. Primary infection with
VZV results in varicella, a contagious rash that typically occurs
in children. As antibodies are produced and the primary disease
heals, VZV lies dormant in the trigeminal and dorsal root gan-
glia. Reactivation of dormant VZV leads to a painful, maculo-
papular rash termed herpes zoster. When the rash is present on
the tip of the nose, it is called Hutchinson sign. This implies
involvement of the nasal branch of the nasociliary nerve and
raises the concern regarding serious ophthalmologic complica-
tions1 (uveitis, keratitis and blindness). Thus, urgent consulta-
tion with an ophthalmologist is indispensable in all cases of
herpes zoster with Hutchinson sign. Early treatment can pre-
vent ophthalmologic complications and postherpetic neuralgia.
Photographs and text from: H. Matsuura, Department of
General Internal Medicine, Kurashiki Central Hospital, 1-1-1,
Miwa, Kurashiki-city, Okayama 710-8602, Japan and
Department of General Internal Medicine, Mitoyo General
Hospital, 708, Himehama, Toyohama-cho, Kanonji-city, Kagawa
769-1695, Japan; A. Senoo, Department of Dermatology, Mitoyo
General Hospital, 708, Himehama, Toyohama-cho, Kanonji-city,
Kagawa 769-1695, Japan. email: superonewex0506@yahoo.co.jp
Conflict of interest: None declared.
Reference
1. Gnann JW, Whitley RJ. Herpes zoster. N Engl J Med 2002; 347:
340–6.
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