“A painful rash on my forehead — it’s near my eye”

A painful, dermatomal, unilateral, blistering rash that doesn’t cross the midline, with a prodrome of pain/tingling, is shingles (herpes zoster) — not a cold sore or allergy — and oral antivirals should start promptly (ideally within ~72 hours; and regardless here given ophthalmic involvement and immunosuppression). The examinable emergency is HERPES ZOSTER OPHTHALMICUS: rash in the ophthalmic (V1) distribution involving the side/tip of the nose (HUTCHINSON’S SIGN — nasociliary nerve) with a red, gritty eye threatens the eye (keratitis, uveitis, vision loss) and needs SAME-DAY ophthalmology assessment — the eye involvement transforms a "give me a cream" consultation into a sight-saving one. Manage pain and counsel post-herpetic neuralgia (common in older patients), give infection-control advice (avoid contact with the immunosuppressed, pregnant women, non-immune neonates until crusted), and address the methotrexate concern (it didn’t cause it, but immunosuppression raises risk/severity; don’t stop without advice). The hidden agenda is "don’t want to make a fuss"/event worry; convey the eye risk clearly but calmly and act urgently.