History: A 68-year-old man presented with progressive ulceration of the left nasal ala. Approximately 6 weeks prior, the patient had experienced a herpes zoster infection involving the V2 distribution of his left face. He stated that a sore developed on the rim of his left nostril 2 weeks following the herpes zoster infection. While he initially denied any picking or scratching of the wound his wife admitted that the patient frequently touched and manipulated the area.
Allergies: No known drug allergies
Laboratory Results: He had a normal CBC, ESR, ANA, and RF. A culture of the lesion showed growth of normal flora.
Physical Exam: Physical examination revealed a white plaque with ulceration and crusting of the left lateral nasal ala rim and vestibule approximately 1cm in size. The ulceration was in the shape of a crescent (Image 1). The lesion was not tender to palpation. Neurological examination revealed decreased perception of light touch and pain sensation over the trigeminal area.
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