Which physical findings suggest herpes occipiticollaris?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Herpes occipiticollaris involves the posterior scalp, the nuchal area, portions of the ear, and portions of the lower mandible and anterior neck (see the image below). Vertebral nerves C2 and C3 often are involved together. Branches of these 2 vertebral nerves communicate with CN VII and CN X, sometimes causing symptoms related to these cranial nerves as well.

Herpes zoster on neck. Herpes zoster on neck.

Nuchal or scalp involvement occasionally is confused with folliculitis, furunculosis, cellulitis, erysipelas, or acne keloidalis nuchae. The painful prodrome can result in confusion and misdiagnosis until the classic vesicular rash appears.

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