V1 Herpes Zoster

This was a harder image than I thought it would be.  Several of you missed it, and I don't know why, except that it is a lesion you couldn't just glance at on your iPhone.  To me, when I see certain images, I immediately look to rule out other possibilities on my way to the diagnosis. and in this case I would have eliminated everything else in my ddx because the lesions a) are unilateral and b) extend onto the nose, both at the root and at the sidewall.  Although this is not Hutchinson's Sign, per se, since that is associated with nasal tip involvement, it is nasal involvement and you should refer to ophthalmology, for no other reason than that Morgan and Morgan will smoke you like a cheap cigar if you don't and if the patient gets HZ ophthalmicus.  

For those who do not live in our area, M&M are the slimy ambulance chasers from Orlando who are always on TV.  Of course, the involvement of the nasal tip is also V1 HZV, via the nasociliary nerve (a nerve you should remember all your long lives).