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Hutchinson Sign — RACP Adult Medicine MCQ

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EasyDermatologyHutchinson SignRACP Adult Medicine

A 40-year-old man presents with a vesicular rash in the distribution of the ophthalmic division of the trigeminal nerve (V1). There are vesicles on the tip of his nose (Hutchinson sign). What is the significance of Hutchinson sign?

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Correct answer: C — It indicates trigeminal neuralgia

Hutchinson sign (vesicles on the tip of the nose) indicates involvement of the nasociliary branch of V1, which also supplies the cornea. It is associated with a significantly increased risk (~75%) of herpes zoster ophthalmicus (keratitis, uveitis, and potentially vision loss). Urgent ophthalmology referral is essential. IV aciclovir (or high-dose oral valaciclovir) should be commenced, and topical ophthalmic antivirals and steroids prescribed by ophthalmology.

Reference: eTG – 2025 – Dermatology; eTG – 2025 – Antibiotic Guidelines