What is the diagnosis for a 1.5 cm small lesion on the right forearm with associated redness and no discharge, in a patient with a history of healed shingles (herpes zoster) on her hand?

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Differential Diagnosis for Right Hand Lesion

Single Most Likely Diagnosis

  • Herpes Zoster (Shingles): Given the patient's history of healed shingles and the presence of a new lesion on the same hand, it is likely that the patient is experiencing a recurrence or a new outbreak of shingles. The description of redness without discharge is also consistent with this diagnosis.

Other Likely Diagnoses

  • Contact Dermatitis: The patient's lesion could be an allergic or irritant reaction to something that came into contact with their hand, resulting in redness and inflammation.
  • Cellulitis: A bacterial infection of the skin and underlying tissues, which could cause redness, swelling, and warmth, although discharge is not typically absent in cellulitis.
  • Eczema (Atopic Dermatitis): A chronic skin condition characterized by dry, itchy, and inflamed skin, which could present with redness and small lesions.

Do Not Miss Diagnoses

  • Necrotizing Fasciitis: A life-threatening bacterial infection that can cause severe pain, redness, and swelling, often with no discharge initially. Although rare, it is crucial to consider this diagnosis due to its high mortality rate if left untreated.
  • Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection: A type of bacterial infection that can cause skin lesions, redness, and swelling, and can be severe if not treated promptly.

Rare Diagnoses

  • Erythema Multiforme: A skin condition characterized by target-shaped lesions, which could present with redness and small lesions, although it is typically more widespread and associated with other symptoms.
  • Lymphomatoid Papulosis: A rare skin condition that can cause small, red, and inflamed lesions, often with no discharge, although it is typically more chronic and recurrent.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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