Herpes zoster, also known as shingles, is the most common infectious process that presents in a dermatomal pattern. Herpes zoster is caused by reactivation of the varicella-zoster virus, which lies within the dorsal root ganglion of a spinal nerve. This condition commonly results in a dermatomal distribution of vesicles/bullae on an erythematous base.
Neoplasms—including common cutaneous malignancies, such as basal cell carcinoma, as well as rare benign cutaneous conditions, such as cutaneous schwannoma, may have a distribution similar to that of segmental NF. A biopsy can help distinguish the diagnosis. See the TABLE4 for a complete differential diagnosis for dermatomally distributed nodules.
Classifying neurofibromatosis
It’s important to classify the type of NF in order to get a better handle on the patient’s prognosis and to facilitate genetic counseling. In particular, the much more common NF1 comes with an increased risk of systemic findings such as malignant peripheral nerve sheath tumors, optic gliomas, other gliomas, and leukemia. Few patients with segmental NF, on the other hand, will have these systemic findings.4 Segmental NF treatment typically focuses on symptomatic management or cosmetic concerns.
Our patient did not have any of the systemic complications that occasionally occur with segmental NF as discussed above, so no medical treatment was required. We informed him that the cutaneous and subcutaneous neurofibromas do not require removal unless there is pain, bleeding, disfigurement, or signs of malignant transformation. Our patient was not interested in removal of the nodules for cosmetic reasons, so we recommended follow-up as needed.
CORRESPONDENCE
Thomas M. Beachkofsky, MD, FAAD, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234; thomas.beachkofsky@us.af.mil.