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Enlarging purple pruritic nodules on the dorsal neck
The Clinical Advisor, 11/05/09

Sonabend M – A 34–year–old African American man presented to our clinic for evaluation of enlarging purple nodules over his neck. The lesions, which had first appeared two months earlier, caused significant itching. A painful rash had preceded the nodules by about a month, but the eruption had resolved after about a week. The patient, who was HIV–positive, reported that his CD4 count had been stable on antiretroviral therapy. A physical examination revealed no other lesions or abnormalities. There was no family history of similar nodules. The patient wanted to know what could be done for these new lesions...The patient's nodules were keloid scars due to herpes zoster. Corticosteroids are the mainstay of standard treatment. Intralesional triamcinolone is more effective than topical treatment. For topical treatment, occlusion, such as with flurandrenolide tape, is more effective than creams. More persistent lesions can be treated with intralesional 5–fluorouracil, radiation, and cryosurgery. While excision of keloids with primary closure can be used, the risk for recurrence is high. To mitigate this risk, imiquimod (Aldara) and silicone sheeting should be applied topically while triamcinolone is injected intralesionally into the healing wound.

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