Skin nontumor
Infectious disorders
Herpes simplex / zoster

Topic Completed: 1 September 2010

Minor changes: 14 July 2020

Copyright: 2002-2019,, Inc.

PubMed Search: Herpes simplex [title] AND varicella zoster [title]<

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M Herpes simplex / zoster. website. Accessed August 7th, 2020.
Definition / general
  • Painful diseases caused by herpes simplex virus (HSV) or varicella zoster virus (VZV, also causes chickenpox)
Clinical features
  • For both viruses, after primary infection, viral particles reside in sensory ganglia and are dormant until they erupt as recurrent herpes simplex virus or shingles (zoster)
  • The two viruses are differentiated by culture (difficult to culture zoster) or immunologic methods

  • Herpes simplex:
    • Historically, HSV1 was associated with herpes labialis (90%), and HSV2 was associated with herpes genitalis (90%), although in some recent studies, most genital lesions are caused by HSV1
    • Visceral involvement is most often seen in the lung, liver and brain
    • Today, diagnosis is often confirmed by PCR or immunohistochemistry
    • The multinucleated cells are the diagnostic features of the historic Tzank test, a Giemsa stained smear of vesicle contents
    • In the past, the laboratory diagnosis of herpes infection was confirmed by growth in tissue culture, electron microscopy, immunofluorescence of viral specific protein or viral DNA hybridization

  • Varicella zoster:
    • Varicella zoster is associated with leukemia and lymphoma, SLE and postradiation or postchemotherapy status
    • Occurs in 40 - 50% of patients in the first year following bone marrow transplantation
    • Shingles has dermatomal distribution or severe involvement of trigeminal nerve-first division (ophthalmic division) with corneal ulceration and herpetic keratitis

  • Description:
    • Grouped vesicles on an erythematous base, later become pustules, then crusts
Case reports
  • Acyclovir; also valacyclovir, penciclovir and famciclovir (eMedicine)
Clinical images
Contributed by Dr. Mark R. Wick

Breast skin

Images hosted on other servers:

Dermatomal distribution of zoster

Verrucous varicella zoster on leg

Microscopic (histologic) description
  • Keratinocytes are multinucleated, acantholytic with distinct nuclear inclusions, found initially in follicular epithelium
  • Late epidermal necrosis or full-thickness acantholysis
  • Dermal nerve twigs may exhibit a perineural infiltrate of lymphocytes and neutrophils, sometimes associated with intraneural involvement
  • Schwann cell hypertrophy and frank neural necrosis are occasionally encountered
Microscopic (histologic) images

Contributed by Hillary Rose Elwood, M.D.

Viral cytopathic effect of multinucleation, molding, nuclear marginatio

 Case of the Week #423

Herpes virus vesicular dermatitis

Images hosted on other servers:

Multinucleated cells, some with intranuclear inclusions

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