Skin nontumor

Infectious disorders

Herpes simplex / zoster

Last author update: 1 September 2010
Last staff update: 24 October 2022

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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 September 25th, 2023.
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 Mark R. Wick, M.D.

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 margination

Case #423

Herpes virus vesicular dermatitis

Images hosted on other servers:

Multinucleated cells, some with intranuclear inclusions

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