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Ultimately, the patient was diagnosed with herpes zoster (shingles) with superficial cellulitis.
The treating physicians prescribed gabapentin & topical capsaicin for treatment of the resultant pain, and cephalexin for treatment of the superficial cellulitis.

It is notable that acyclovir was not prescribed.
While oral acyclovir 800 mg/day has been shown to decrease incidence of post-herpetic neuralgia at six months by almost 50 percent, its use is clinically most beneficial 48 to 72 hours after onset*—far earlier than our patient presented.

*Source: The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis. Jackson JL, Gibbons R, Meyer G, et al. Arch Intern Med. 1997;157(8):909-912.
Case presented by John Phillip Sherrod, MD, David Boyd, MD, and Ronald Billips, MD, St. Francis Family Medicine, Midlothian, VA.

Type 2 diabetic male experiencing painful rash

Ronald Billips, MD

Family Medicine Physician at Princeton Community Hospital

David Boyd, MD

Family Practitioner at Western Regional Medical Center

John P. Sherrod, MD

Family Medicine Physician at St. Francis Family Medicine
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