Herpes zoster in Child
See also in: Cellulitis DDx,Anogenital,Hair and Scalp,Oral Mucosal LesionAlerts and Notices
Synopsis
Involvement of the ophthalmic branch of the trigeminal nerve may lead to herpes zoster ophthalmicus. Herpes zoster oticus (Ramsay-Hunt syndrome) occurs with involvement of the vestibulocochlear nerve. Herpes zoster duplex is the simultaneous occurrence of zoster in 2 noncontiguous dermatomes and herpes zoster multiplex refers to this phenomenon occurring in more than 2 dermatomes. While most patients with herpes zoster duplex or multiplex are adults, children affected by this condition have also been reported.
Although the onset of cutaneous zoster in adults typically involves a 1- to 3-day prodrome of burning pain or tingling in the affected dermatome, this is rarely observed in children. Postherpetic neuralgia is also rare in children. Other less frequently encountered post-zoster sequelae include herpes zoster granulomatous dermatitis.
If it occurs, zoster encephalitis usually appears in the first 2 weeks after the onset of lesions and has a 10%-20% mortality rate. Disseminated zoster occurs 5-10 days after the onset of dermatomal disease. It is defined as more than 20 lesions outside the initial dermatome of involvement.
Immunocompromised patient considerations: Immunocompromised patients have a higher risk of disseminated zoster. In patients with HIV and AIDS, multidermatomal, necrotic, or recurrent zoster may occur. Persistent ulcers and chronic hyperkeratotic zoster are further manifestations. A strong association of herpes zoster multiplex with underlying malignancy (especially lymphoma) was reported in one retrospective study.
Codes
ICD10CM:B02.9 – Zoster without complications
SNOMEDCT:
4740000 – Herpes zoster
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Herpes simplex virus infection occurring within a dermatomal distribution is the primary differential diagnosis. Serology, viral culture, or polymerase chain reaction (PCR) may be necessary to distinguish this diagnosis from zoster.
- Allergic contact dermatitis may present as a well-defined vesicular plaque. A dermatomal distribution suggests zoster.
- Molluscum contagiosum, when inflamed, can be confused with varicella-zoster. Cases are typically of longer duration, and VZV PCR studies are negative. The presence of coexisting noninflamed molluscum lesions is a helpful diagnostic clue.
- Cellulitis or erysipelas
- Folliculitis
- Herpangina
- Insect bites
- Other poxviruses (cowpox, monkeypox)
- Pyoderma gangrenosum
- Primary varicella infection and disseminated varicella
- Urticaria
- Bullous fixed drug eruption
- Eczema herpeticum
- Vasculitis
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Management Pearls
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Therapy
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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.Subscription Required
References
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Last Reviewed:04/11/2018
Last Updated:10/11/2021
Last Updated:10/11/2021
Patient Information for Herpes zoster in Child
Overview
Herpes zoster, commonly called shingles, is a painful rash caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains inactive (dormant) in certain nerves in the body. As you age, your immune system becomes weaker and may not be strong enough to control the virus. Shingles occurs when the virus becomes active again, growing down the nerves to reach the skin and appearing as small, painful, fluid-filled bumps (blisters).Who’s At Risk
Although anyone who has had chickenpox or the chickenpox vaccine can get shingles, it usually occurs in people older than 50. People in their 70s are 15 times more likely to get shingles than younger adults. It can also be seen in people with weakened immune systems, such as those with cancer, organ transplants, autoimmune diseases, and HIV/AIDS. Shingles affects approximately 1 million people in the United States each year. Most people who have shingles will not get it again, although on rare occasions, it can reappear.Signs & Symptoms
Pain, itching, and burning or tingling in a specific location on the skin are the first shingles symptoms that develop. After a few days, the affected area will develop painful, smooth, red papules (small, solid bumps). In darker skin colors, the redness may be harder to see, but clustered bumps can be felt. The papules become vesicles (small blisters that are firm to the touch) over 1-2 days and then burst after 5-7 days, leaving sores on the skin that eventually form scabs. Individuals with shingles may also have fever, chills, headache, and generalized body aches. Because the virus travels down a nerve to the skin, shingles usually appears on only one side of the body and affects a specific area of the skin. Shingles commonly occurs on the chest, but it may also affect other parts of the body, including the face. The blisters may be in a cluster or in a linear pattern. Most people completely recover from shingles within 4 weeks.A particularly serious form of shingles occurs on the face and can affect the eye, possibly affecting vision if it is not promptly treated.
One of the most common complications of shingles is chronic pain in the area of the skin where the rash occurred. This is called postherpetic neuralgia. It is more common in older individuals and in people who had severe symptoms with the initial rash. It occurs in almost half of people who are older than 60 when they get shingles.
Self-Care Guidelines
Although shingles usually heals without medical care, call your health professional if you suspect shingles before following these self-care instructions:- Keep the area clean with mild soap and water.
- For pain, apply cool, damp compresses, and take either acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
- Apply calamine (Caladryl) lotion to help relieve itching.
When to Seek Medical Care
Call your health provider if you think you may have shingles, as there are medications that may speed healing if they are given within the first 72 hours after the rash appears.Treatments
Oral antiviral medication, such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) may help if given within 72 hours after shingles lesions first appear. These medicines do not cure shingles, but they can decrease the amount of time you have pain and a rash. Antiviral medications may also decrease your chance of getting postherpetic neuralgia and may decrease your risk of developing visual problems if you have shingles on the face.Oral corticosteroids and pain relievers, such as acetaminophen and ibuprofen, may also be given to control pain. If the area is healed but you still have pain, your health provider may prescribe a topical medication called capsaicin (Capzasin P, Zostrix) or a cream or local anesthetic patch containing lidocaine (Lidoderm).
If you have shingles on your face, your health provider will likely send you to an eye specialist to evaluate if the virus is affecting your eye.
The Centers for Disease Control and Prevention (CDC) recommends the vaccine Shingrix to prevent shingles and postherpetic neuralgia. It is recommended for anyone older than 50, regardless of whether they have had shingles before. It is a two-dose injection that can be given by a clinician or pharmacist in the upper arm.
Herpes zoster in Child
See also in: Cellulitis DDx,Anogenital,Hair and Scalp,Oral Mucosal Lesion