Clustered vesicular lesions over the upper limb in an elderly male: cutaneous herpes zoster

A 62-year-old elderly male presented to the Dermatology Outpatient Department with complaints of painful skin eruptions over the right upper limb for the past two weeks. The patient reported that the lesions initially appeared as small fluid-filled blisters associated with a burning sensation and mild itching. Over the following days, the lesions gradually increased in number and size and were accompanied by localised pain, tenderness, and discomfort. The patient denied any history of trauma, insect bites, or similar lesions elsewhere on the body. He also reported difficulty performing routine activities due to persistent burning pain over the affected region. On dermatological examination, multiple grouped vesicular and vesiculobullous lesions were observed over the extensor surface of the right forearm extending toward the elbow. Some vesicles were tense and intact, while others had ruptured, resulting in superficial erosions, crusting, and mild serous discharge. The surrounding skin showed erythema with areas of post-inflammatory hyperpigmentation. A few excoriation marks were also present due to scratching. The lesions followed a localised dermatomal distribution over the upper limb. Based on the characteristic clustered vesicles, associated burning pain, and dermatomal distribution, a clinical diagnosis of Herpes zoster was established. This condition results from reactivation of the Varicella zoster virus, which remains latent in sensory nerve ganglia after primary infection. The patient was treated with oral antiviral therapy such as Acyclovir along with analgesics and supportive topical care, leading to gradual healing of the lesions without complications.