A 15-year-old comes to clinic with painful vesicular skin lesions. The most likely diagnosis is:

A 15-year-old comes to clinic with painful vesicular skin lesions. The most likely diagnosis is:

• A. Impetigo
• B. Coxsackievirus infection
• C. Herpes infection
• D. Molluscum contagiosum

Answer: (C)

Painful grouped vesicles in an adolescent best point to a herpes simplex virus infection. HSV lesions are classically small vesicles that cluster on an erythematous base and are notably painful, which helps distinguish them from other common vesicular rashes. In teens, this can present as genital herpes or oral/genital HSV infections, with pain that stands out relative to surrounding tissue. Impetigo, by contrast, tends to have honey-colored crusts after pustules and is usually not vesicular or painfully symptomatic. Coxsackievirus infections can cause vesicular lesions, but they typically have a characteristic distribution, such as on the hands, feet, and mouth, rather than a confined painful vesicular cluster. Molluscum contagiosum presents as smooth, dome-shaped papules with central umbilication, not vesicles and not usually painful.

Painful grouped vesicles in an adolescent best point to a herpes simplex virus infection. HSV lesions are classically small vesicles that cluster on an erythematous base and are notably painful, which helps distinguish them from other common vesicular rashes. In teens, this can present as genital herpes or oral/genital HSV infections, with pain that stands out relative to surrounding tissue. Impetigo, by contrast, tends to have honey-colored crusts after pustules and is usually not vesicular or painfully symptomatic. Coxsackievirus infections can cause vesicular lesions, but they typically have a characteristic distribution, such as on the hands, feet, and mouth, rather than a confined painful vesicular cluster. Molluscum contagiosum presents as smooth, dome-shaped papules with central umbilication, not vesicles and not usually painful.