Dermatologic Manifestations of Herpes Zoster

  • Ranjani Somayaji
  • James A. Elliott
  • R. Gary SibbaldEmail author


Herpes zoster (HZ), also called ‘shingles’, is a unique neurocutaneous entity that has been recognized since historic times. HZ represents a recurrent infection state of varicella-zoster virus (VZV) and commonly occurs in elderly [46] and immunocompromised hosts [63]. This chapter will focus on dermatological issues regarding diagnosis, pathology, cutaneous complications and management of HZ.


  1. 1.
    Anderson DJ, Janoff EN (1987) Herpes zoster infection in a patient on methotrexate given prednisone to prevent post-herpetic neuralgia. Ann Intern Med 107:783CrossRefPubMedGoogle Scholar
  2. 2.
    Appelman D (1955) Treatment of herpes zoster with ACTH. N Engl J Med 20:693–695CrossRefGoogle Scholar
  3. 3.
    Arvin A, Pollard R, Rasmussen L, Merigan T (1980) Cellular and humoral immunity in the pathogenesis of recurrent herpes viral infections in patients with lymphoma. J Clin Invest 65:869–878CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bastian FO, Rabson AS, Yee CL (1974) Herpesvirus varicellae isolated from human dorsal root ganglia. Arch Pathol 97:331–333PubMedGoogle Scholar
  5. 5.
    Bisaccia E, Scarborough DA, Carr RD (1983) Cutaneous sarcoid granuloma formation in herpes zoster scars. Arch Dermatol 119:788–789CrossRefPubMedGoogle Scholar
  6. 6.
    Brunell PA, Kotchmar GSJ (1981) Zoster in infancy: failure to maintain virus latency following intrauterine infection. J Pediatr 98:71–73CrossRefPubMedGoogle Scholar
  7. 7.
    Brunsgaard E (1932) The mutual relation between zoster and varicella. Br J Dermatol Syph 44:1–21CrossRefGoogle Scholar
  8. 8.
    Burgoon CJ, Burgoon J, Baldridge G (1957) The natural history of herpes zoster. JAMA 164:265–269CrossRefGoogle Scholar
  9. 9.
    CDC (2013) Preventing varicella in health care settings [WWW Document]. Cent. Dis. Control Prev. URL Accessed 6.1.16Google Scholar
  10. 10.
    Chang C, Woo E, Yu Y, Huang C, Chin D (1987) Herpes zoster and its neurological complications. Postgrad Med J 63:85–89CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Chen N, Li Q, Yang T et al. (2014) Antiviral therapy for the treatment of postherpetic neuralgia. Cochrane Database Syst Rev (2): CD006866Google Scholar
  12. 12.
    De Moragas JM, Kierland RR (1957) The outcome of patients with herpes zoster. AMA Arch Derm 75:193–196CrossRefPubMedGoogle Scholar
  13. 13.
    Dolin R, Reichman RC, Mazur MH, Whitley RJ (1978) Herpes zoster-varicella infections in immunosuppressed patients. Ann Intern Med 89:375–388CrossRefPubMedGoogle Scholar
  14. 14.
    Dworkin RH, Boon RJ, Griffin DR, Phung D (1998) Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. J Infect Dis:S76–S80Google Scholar
  15. 15.
    Easton H (1970) Zoster sine herpete causing acute trigeminal neuralgia. Lancet 2:1065–1066CrossRefPubMedGoogle Scholar
  16. 16.
    Elliott FA (1964) Treatment of herpes zoster with high doses of prednisone. Lancet 2:610–611CrossRefPubMedGoogle Scholar
  17. 17.
    Enders G (1984) Varicella-zoster virus infection in pregnancy. Prog Med Virol 29:166–196PubMedGoogle Scholar
  18. 18.
    Eyal A, Friedman M, Peretz B, Paldi E (1983) Pregnancy complicated by herpes zoster. A report of two cases and literature review. J Reprod Med 28:600–603PubMedGoogle Scholar
  19. 19.
    Forghani B, Schmidt N, Dennis J (1978) Antibody assays for varicella-zoster virus: comparison of enzyme immunoassay with neutralization, immune adherence hemagglutination, and complement fixation. J Clin Microbiol 8:545–552PubMedPubMedCentralGoogle Scholar
  20. 20.
    Frank L, Lysiak R (1953) Herpetic and post-herpetic pain treated with cortisone and ACTH. N Y State J Med 53:2379PubMedGoogle Scholar
  21. 21.
    Fugelso PD, Reed WB, Newman SB, Beamer JE (1973) Herpes zoster of the anogenital area affecting urination and defaecation. Br J Dermatol 89:285–288CrossRefPubMedGoogle Scholar
  22. 22.
    Galil K, Choo P, Donahue JG, Platt R (1997) The sequelae of herpes zoster. Arch Intern Med 157:1209–1213CrossRefPubMedGoogle Scholar
  23. 23.
    Garland J (1943) Varicella following exposure to herpes zoster. N Engl J Med 228:336–337CrossRefGoogle Scholar
  24. 24.
    Gelfand ML (1954) Treatment of herpes zoster with cortisone. JAMA 154:911–912CrossRefGoogle Scholar
  25. 25.
    Ghatak N, Zimmerman H (1973) Spinal ganglion in herpes zoster. A light and electron microscopic study. Arch Pathol 95:411–415PubMedGoogle Scholar
  26. 26.
    Gilden DH, Dueland AN, Cohrs R, Martin JR, Kleinschmidt-DeMasters BK, Mahalingam R (1991) Preherpetic neuralgia. Neurology 41:1215–1218CrossRefPubMedGoogle Scholar
  27. 27.
    Gnann J, Whitley RJ (1991) Natural history and treatment of varicella-zoster in high-risk populations. J Hosp Infect 18:317–329CrossRefPubMedGoogle Scholar
  28. 28.
    Gordon J, Meader FM (1929) The period of infectivity and serum prevention of chickenpox. JAMA 93:2013–2015CrossRefGoogle Scholar
  29. 29.
    Harrison RA, Soong S, Weiss HL, Gnann JWJ, Whitley RJ (1999) A mixed model for factors predictive of pain in AIDS patients with herpes zoster. J Pain Symptom Manage 17:410–417CrossRefPubMedGoogle Scholar
  30. 30.
    Hato N, Kisaki H, Honda N, Gyo K, Murakami S, Yanagihara N (2000) Ramsay Hunt syndrome in children. Ann Neurol 48:254–256CrossRefPubMedGoogle Scholar
  31. 31.
    Hope-Simpson RE (1965) The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Soc Med 58:9–20PubMedPubMedCentralGoogle Scholar
  32. 32.
    Huff JC (1988) Antiviral treatment in chickenpox and herpes zoster. J Am Acad Dermatol 18:204–206CrossRefPubMedGoogle Scholar
  33. 33.
    Huff JC, Bean B, Balfour HHJ, Laskin OL, Connor JD, Corey L, Bryson YJ (1988) Therapy of herpes zoster with oral acyclovir. Am J Med 85:84–89CrossRefPubMedGoogle Scholar
  34. 34.
    Jemsek J, Greenberg SB, Taber L, Harvey D, Gershon A, Couch RB (1983) Herpes zoster-associated encephalitis: clinicopathologic report of 12 cases and review of the literature. Medicine Baltimore 62:81–97CrossRefPubMedGoogle Scholar
  35. 35.
    Kundratitz K (1925) Experimentelle Übertragungen von Herpes zoster auf Menschen und die Bezichungen von Herpes zoster zu Varicellen. Z Für Kinderheilkd 39:379–387CrossRefGoogle Scholar
  36. 36.
    Lal H, Cunningham AL, Godeaux O et al (2015) Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 372(22):2087–2296CrossRefGoogle Scholar
  37. 37.
    Landthaler M, Heuser M (1979) Paralytic abdominal hernia in zoster. Hautarzt 30:432–433PubMedGoogle Scholar
  38. 38.
    Leinweber B, Kerl H, Cerroni L (2006) Histopathologic features of cutaneous herpes virus infections (herpes simplex, herpes varicella/zoster): a broad spectrum of presentations with common pseudolymphomatous aspects. Am J Surg Pathol 30:50–58CrossRefPubMedGoogle Scholar
  39. 39.
    Leung J, Harpaz R, Baughman AL, Heath K, Loparev V, Vázquez M, Watson BM, Schmid DS (2010) Evaluation of laboratory methods for diagnosis of varicella. Clin Infect Dis 51:23–32CrossRefPubMedGoogle Scholar
  40. 40.
    Levinson W, Shaw JC (1985) Treatment of herpes zoster with corticosteroids--fact or faith? West J Med 142:117–118PubMedPubMedCentralGoogle Scholar
  41. 41.
    Lewis GW (1958) Zoster sine herpete. Br Med J 2:418–421CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Mills K (1986) Herpes zoster and corticosteroid therapy. Med J Aust 145:60PubMedGoogle Scholar
  43. 43.
    Nagasako EM, Johnson RW, Griffin DR, Dworkin RH (2002) Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. J Am Acad Dermatol 46:834–839CrossRefPubMedGoogle Scholar
  44. 44.
    Nickel WR (1951) Herpes Zoster Treated with ACTH. AMA Arch Derm Syphilol 64:372CrossRefGoogle Scholar
  45. 45.
    Portenoy RK, Duma C, Foley KM (1986) Acute herpetic and postherpetic neuralgia: clinical review and current management. Ann Neurol 20:651–664CrossRefPubMedGoogle Scholar
  46. 46.
    Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO (1982) Population-based study of herpes zoster and its sequelae. Medicine Baltimore 61:310–316CrossRefPubMedGoogle Scholar
  47. 47.
    Rogers RS 3rd, Tindall JP (1972) Herpes zoster in children. Arch Dermatol 106:204–207CrossRefPubMedGoogle Scholar
  48. 48.
    Roizenblatt S, Rosa NS (2014) Herpes zoster involving the S1 dermatome. N Engl J Med 370:2031–2031. doi: 10.1056/NEJMicm1311499 CrossRefPubMedGoogle Scholar
  49. 49.
    Sauer GC (1955) Herpes zoster; treatment of postherpetic neuralgia with cortisone, corticotropin, and placebos. AMA Arch Derm 71:488–491CrossRefPubMedGoogle Scholar
  50. 50.
    Schimpff S, Serpick A, Stoler B, Rumack B, Mellin H, Joseph JM, Block J (1972) Varicella-zoster infection in patients with cancer. Ann Intern Med 76:241–254CrossRefPubMedGoogle Scholar
  51. 51.
    Schmader KE, Studenski S (1989) Are current therapies useful for the prevention of postherpetic neuralgia? A critical analysis of the literature. J Gen Intern Med 4:83–89CrossRefPubMedGoogle Scholar
  52. 52.
    Sokal JE, Firat D (1965) Varicella-zoster infection in Hodgkin’s disease: clinical and epidemiological aspects. Am J Med:452–463Google Scholar
  53. 53.
    Steiner P (1875) Zur inokulation der varicellen. Wien Med Wochenschr 25:306Google Scholar
  54. 54.
    Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC (2014) Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 59:147–159CrossRefPubMedGoogle Scholar
  55. 55.
    Sulzberger MB, Sauer GC, Herrmann F, Baer RL, Milberg IL (1951) Effects of ACTH and cortisone on certain diseases and physiologic functions of the skin: I Effects of ACTH. J Invest Dermatol 16:323–337CrossRefPubMedGoogle Scholar
  56. 56.
    Sutton G (1984) Steroidstoss therapy in the treatment of herpes zoster. Br J Clin Pract 38:21–24PubMedGoogle Scholar
  57. 57.
    Taylor-Robinson D, Caunt AE (1972) Varicella virus. Springer, ViennaCrossRefGoogle Scholar
  58. 58.
    Tyring S, Barbarash RA, Nahlik JE, Cunningham A, Marley J, Heng M, Jones T, Rea T, Boon R, Saltzman R (1995) Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Ann Intern Med 123:89–96CrossRefPubMedGoogle Scholar
  59. 59.
    Tyring SK (1992) Natural history of varicella zoster virus. Semin Dermatol 11:211–217PubMedGoogle Scholar
  60. 60.
    Tyring SK, Beutner K, Tucker BA, Anderson WC, Crooks RJ (2000) Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med 9:863–869CrossRefPubMedGoogle Scholar
  61. 61.
    Tyzzer EE (1906) The histology of the skin lesions in varicella. J Med Res 14:361–392PubMedPubMedCentralGoogle Scholar
  62. 62.
    Weller TH, Witton HM (1958) The etiologic agents of varicella and herpes zoster; serologic studies with the viruses as propagated in vitro. J Exp Med 108:869–890CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Whitley RJ (2015) Chickenpox and herpes zoster (Varicella-Zoster Virus). In: Bennett JE, Dolin R, Blaser MJ (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Elsevier Saunders, Philadelphia, pp 1731–1737CrossRefGoogle Scholar
  64. 64.
    Whitley RJ, Weiss H, Gnann JWJ, Tyring S, Mertz GJ, Pappas PG, Schleupner CJ, Hayden F, Wolf J, Soong SJ (1996) Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med 125:376–383CrossRefPubMedGoogle Scholar
  65. 65.
    Wolf R, Wolf D, Ruocco E, Brunetti G, Roucco V (2011) Wolf’s isotopic response. Clin Dermatol 29:237–240CrossRefPubMedGoogle Scholar
  66. 66.
    Wood MJ, Johnson RW, McKendrick MW, Taylor J, Mandal BK, Crooks J (1994) A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 330:896–900CrossRefPubMedGoogle Scholar
  67. 67.
    Wood MJ, Ogan PH, McKendrick MW, Care CD, McGill JI, Webb EM (1988) Efficacy of oral acyclovir treatment of acute herpes zoster. Am J Med 85:79–83PubMedGoogle Scholar
  68. 68.
    Wright AL, Cotton DW, Winfield DA, Messenger AG (1989) Granuloma formation in herpes zoster scars. Dermatologica 179:46–46Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Ranjani Somayaji
    • 1
  • James A. Elliott
    • 2
  • R. Gary Sibbald
    • 3
    • 4
    Email author
  1. 1.Division of Infectious Disease, Department of MedicineUniversity of CalgaryCalgaryCanada
  2. 2.Toronto Regional Wound Healing ClinicMississaugaCanada
  3. 3.Dalla Lana Faculty of Public Health and Department of MedicineFaculty of Medicine, University of TorontoTorontoCanada
  4. 4.Trillium Health and PartnersMississaugaCanada

Personalised recommendations