A 65-year-old male develops a cluster of painful vesicles on his right shoulder and right upper arm a few days after taking a hot shower. He comes to you thinking he has either burned his arm or been bitten by a spider in several locations. You think he has another skin condition, specifically:

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Herpes zoster (colloquially known as "shingles") is a blistering, scabbing rash that occurs in a dermatomal distribution, usually in individuals who are immunosuppressed, or in people over the age of 60. The disease is a reactivation of the chickenpox virus in adulthood, and it is preventable with vaccination against Varicella-zoster virus. For months after the rash of shingles resolves, patients may complain of neuropathic pain in the affected site, a condition known as postherpetic neuralgia. Patients often blame rashes on unrecognized spider bites-for example, many patients think that the boils they develop from methicillin-resistant staphylococcus aureus (MRSA) were given to them by a spider bite. Although arachnophobia is common, spider bite rashes are rare.

A 65-Year-Old Male Develops a Cluster of Painful Vesicles on His