What rash should you suspect if an older adult client complains of itching and pain?

The presence of itching and pain in an older adult client strongly suggests a diagnosis of herpes zoster, commonly known as shingles. This condition is caused by the reactivation of the varicella-zoster virus, which remains dormant in the body after a person has experienced chickenpox.

Herpes zoster presents as a painful, blistering rash that often appears on one side of the body, typically in a dermatomal distribution. In addition to the characteristic rash, clients frequently report intense pain, which can occur even before the rash appears. Itching is also a common symptom experienced by individuals suffering from this condition due to the inflammation and irritation of the skin.

Other options, while they may present with some symptoms of itching, do not typically combine both itching and significant pain in the same manner as herpes zoster. Actinic keratosis, for example, is generally not painful, whereas scabies usually causes severe itching without the same level of localized pain. Skin cancer may not present with prominent itching or acute pain early in its course. Therefore, the combination of itching and pain particularly points towards herpes zoster as the most plausible diagnosis.