Herpes zoster in Child
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.
B02.9 – Zoster without complications
4740000 – Herpes zoster
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
- Insect bites
- Other poxviruses (cowpox, mpox)
- Pyoderma gangrenosum
- Primary varicella infection and disseminated varicella
- Bullous fixed drug eruption
- Eczema herpeticum
Drug Reaction Data