Diagnosis

The differential diagnosis includes herpes simplex infections, impetigo, and contact dermatitis. A Tzanck preparation and a viral culture can confirm the diagnosis. The yield is higher when the tests are performed on early intact vesicles. A Tzanck preparation allows for visualization of multinucleated giant cells. It is useful to determine if an eruption is viral in origin; however it is unable to distinguish between herpes simplex and varicella zoster viruses. Viral culture should be obtained by opening a vesicle and scraping the base of a vesicle onto a synthetic (not cotton) swab to be placed in viral culture media. Growth may take as long as one week.

Again, ophthalmic nerve involvement requires an ophthalmology consultation to rule out ocular complications.

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