A 16-year-old high school student developed a rash on his forehead six days ago. Two days after onset, he was seen by a family practitioner who prescribed cephalexin for a suspected staphylococcal infection. Despite treatment, the eruption continued to spread. He complains of mild fatigue but denies fever or swollen glands. He is a wrestler and has a match in two days. Examination of his forehead reveals multiple erythematous papules and papulovesicles.
This patient is experiencing a primary episode of herpes simplex infection, probably acquired from skin-to-skin contact with another wrestler (herpes gladiatorum). He was advised of the contagious nature of the disease and that other wrestlers must not be exposed to active lesions. Herpes gladiatorum most commonly manifests as vesicular lesions on the head and neck. Primary infection may be accompanied by malaise, low-grade fever, and regional lymphadenopathy. This patient was treated with oral valacyclovir.
Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Stairs is an associate with Westmoreland Dermatology in Greensburg, Pennsylvania.
