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Disseminated herpes zoster
Other Resources UpToDate PubMed

Disseminated herpes zoster

Contributors: Naomi So, Susan Burgin MD
Other Resources UpToDate PubMed


Herpes zoster (shingles) is a reactivation of latent infection of varicella-zoster virus (VZV). Disseminated zoster most commonly affects immunocompromised patients and only rarely the immunocompetent population. Dissemination typically occurs 4-11 days after the onset of localized cutaneous disease. Dissemination may be confined to the skin or it may affect the viscera as well. It is estimated that cutaneous dissemination occurs in 10%-40% of immunocompromised patients affected by zoster.

Disseminated cutaneous herpes zoster is defined as more than 20 vesicles outside the primary and adjacent dermatomes. Cutaneous disease itself is not life threatening; however, it is a sign of viremia. In severely immunocompromised patients, this viremia can lead to visceral involvement, which can be life threatening. Visceral dissemination can precede cutaneous disease and has rarely been reported to occur without evidence of cutaneous disease. Visceral involvement can include the lungs, the liver, and the brain. Death is most commonly due to pneumonia.

Patients at highest risk for dissemination include those with lymphoproliferative malignancies, organ transplant recipients, patients with AIDS, and patients receiving systemic corticosteroids. Disseminated zoster may be an early clinical sign of underlying human immunodeficiency virus (HIV) infection in high-risk populations.

Postherpetic neuralgia (PHN), as in localized cutaneous zoster, is a known complication of disseminated zoster.


B02.7 – Disseminated zoster

55560002 – Disseminated herpes zoster

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Herpes simplex virus
  • Varicella
  • Molluscum contagiosum
  • Other poxviruses (Cowpox, Mpox)
  • Eczema herpeticum
  • Folliculitis
  • Meningitis (see Aseptic meningitis)
  • Acute meningococcemia
  • Dermatitis herpetiformis
  • Acneiform eruption (see drug-induced acneiform eruption)
  • Bullous Fixed drug eruption
  • Allergic contact dermatitis
  • Herpangina
  • Urticaria
  • Vasculitis

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:10/17/2018
Last Updated:09/05/2023
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Disseminated herpes zoster
A medical illustration showing key findings of Disseminated herpes zoster : Erythema, Painful skin lesions, Widespread distribution, Umbilicated vesicles
Copyright © 2024 VisualDx®. All rights reserved.