Herpes Zoster

Diagnosis: Herpes Zoster

Clusters of vesicles on a red base in zosteriform array.

Clinical Presentation

Clusters of vesicles on a red base in zosteriform array.

Clinical History

Submitted by Alaa Saad. Originally posted October 27, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Herpes simplex • Contact dermatitis • Cellulitis • Bullous impetigo • Dermatitis herpetiformis • Drug eruption • Insect bites

Key Learnings

• Reactivation of varicella-zoster virus (VZV) from dorsal root ganglia • Dermatomal distribution that does NOT cross the midline is the hallmark • Hutchinson sign: vesicles on tip of nose → nasociliary branch of V1 → ophthalmologic emergency • Ramsay Hunt syndrome: VZV in geniculate ganglion → facial palsy + ear vesicles + otalgia • Post-herpetic neuralgia (PHN) is the most common complication — risk increases with age • Shingrix vaccine (recombinant) >90% effective at preventing zoster — recommended for adults ≥50

Tags: herpes, zoster, alaa saad