A 50-year-old man presents with a red blistering rash that starts on the right torso and wraps around the belt line, with fever and tingling before the rash appears. What is the most likely diagnosis?

• A. Ringworm
• B. Eczema
• C. Shingles
• D. Contact dermatitis

Answer: (C)

Shingles happens when the varicella-zoster virus reactivates in a sensory nerve ganglion, producing a painful, vesicular rash that travels in a narrow band along a single dermatome. The key clues here are the belt-like, unilateral distribution around the torso and the prodromal symptoms of fever and tingling before the rash appears. This dermatomal pattern with preceding sensory symptoms is classic for herpes zoster.

Ringworm would show an annular, scaly lesion with central clearing, not a vesicular band following a dermatome. Eczema presents as itchy, red, often dry or oozing patches without a characteristic dermatomal vesicular distribution. Contact dermatitis causes a localized rash at the exposure site and can be vesicular, but it also lacks the unilateral belt-like dermatomal pattern and prodromal neural symptoms.