Decoding Perianal and Buttock Lesions: Is it Herpes?

Pam Achabal, MSN, RN, CWON1, Dalilah Baugh, BSN, RN, CWOCN2, Michelle Best, BSN, RN, CWOCN3, Ruth Bryant, PhD, RN, CWOCN2, Robin Knaff-Baker, BSN, RN, CWON2, Teresa Patterson, BSN, RN, CWON, CFCN3, Morgan Pitschka, BSN, RN, CWOCN, CFCN4, Rebecca Thomas, BSN, RN, CWOCN3 and Elizabeth Wrigley, BSN, RN, CWON, CFCN3, (1)Hollister, Spokane, WA, (2)Wound and Ostomy, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA, (3)Wound and Ostomy, Sacred Heart Medical Center and Childrens Hospital, SPOKANE, WA, (4)Wound and Ostomy, Northern Idaho Advanced Care Hospital, Post Falls, ID
Lesions that involve the perirectal, perianal, and/or fleshy buttocks are often misdiagnosed as moisture associated skin damage (MASD) or incontinence associated dermatitis (IAD) or pressure ulcers. However, a viral etiology of herpes zoster (shingles) should also be included in the differential.   When a viral etiology is overlooked, appropriate treatment is delayed; and the patient is subjected to prolonged pain, suffering and additional complications.   Furthermore, because hospital acquired pressure ulcers are closely monitored by local and state regulatory agencies, misdiagnosis of viral lesions as hospital acquired pressure ulcers reflects negatively on the health care organization, casting doubt on quality of care and adversely impacting reimbursement. While early primary manifestations of zoster lesions are distinctive and more easily recognized, manifestations of the condition in later phases can be misleading. Vesicles are often replaced with ulcerations and erythema or maceration in the perianal or buttocks area may or may not be present.  In isolation, these physical assessments often lead to an incorrect diagnosis such as MASD, IAD or pressure ulcers.  Subjective assessments (i.e., pain) and medical history (i.e., age, stress, chronicity of illness, immune-suppression) are a significant source of data for discerning the correct etiology.  This presentation will present a holistic discriminating approach that incorporates patient factors, nursing factors, and environment factors to facilitate a prompt and accurate method of identifying and managing perianal and buttocks lesions of viral etiology.