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==Overview==
==Overview==
== Physical Examination ==
== Physical Examination ==
People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. The rash does not usually cross the body’s midline. However, approximately 20% of people have rash that overlaps adjacent dermatomes. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster. This generally occurs only in people with compromised immune systems. Disseminated zoster can be difficult to distinguish from varicella.
Physical examination findings of herpes zoster depend on the location of the rash, as well as the stage of the disease:
 
*Rash: the rash of herpes zoster virus is typically unilateral and does not cross the midline. It follows the distribution of one or two adjacent dermatomes. The rash can involve any area of the body, but most common site are the face ([[ophthalmic]] division of [[trigeminal nerve]]), neck ([[cervical]] dorsal root ganglia) or chest ([[thoracic]] dorsal root ganglia). The rash is initially an erythematous, [[maculopapular]] rash, but over the next 7-10 days, it progresses to pustules and ulceration, with crusts, scabbing or both. Post-inflammatory hyperpigmentation may develop along the affected dermatome(s) as part of the healing process. In the immunocompromised individuals, the rash may be complicated by skin necrosis and scarring.<ref name="pmid23785227">{{cite journal |vauthors=Cohen KR, Salbu RL, Frank J, Israel I |title=Presentation and management of herpes zoster (shingles) in the geriatric population |journal=P T |volume=38 |issue=4 |pages=217–27 |year=2013 |pmid=23785227 |pmc=3684190 |doi= |url=}}</ref><ref name="pmid10375341">{{cite journal |vauthors=Cohen JI, Brunell PA, Straus SE, Krause PR |title=Recent advances in varicella-zoster virus infection |journal=Ann. Intern. Med. |volume=130 |issue=11 |pages=922–32 |year=1999 |pmid=10375341 |doi= |url=}}</ref> 
The rash develops into clusters of clear vesicles. New vesicles continue to form over three to five days and progressively dry and crust over. They usually heal in two to four weeks. There may be permanent pigmentation changes and scarring on the skin.


===Gallery===
===Gallery===

Revision as of 15:09, 24 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Jesus Rosario Hernandez, M.D. [3], Dima Nimri, M.D. [4].

Overview

Physical Examination

Physical examination findings of herpes zoster depend on the location of the rash, as well as the stage of the disease:

  • Rash: the rash of herpes zoster virus is typically unilateral and does not cross the midline. It follows the distribution of one or two adjacent dermatomes. The rash can involve any area of the body, but most common site are the face (ophthalmic division of trigeminal nerve), neck (cervical dorsal root ganglia) or chest (thoracic dorsal root ganglia). The rash is initially an erythematous, maculopapular rash, but over the next 7-10 days, it progresses to pustules and ulceration, with crusts, scabbing or both. Post-inflammatory hyperpigmentation may develop along the affected dermatome(s) as part of the healing process. In the immunocompromised individuals, the rash may be complicated by skin necrosis and scarring.[1][2]

Gallery

Skin

(Images shown below courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

  • Herpes Zoster: Coalesced vesicles resulting from reactivation of HZV infection.

    Herpes Zoster: Coalesced vesicles resulting from reactivation of HZV infection.

  • Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Herpes Zoster: Dermatomally distributed vesicles in patient with HZV infection.

    Herpes Zoster: Dermatomally distributed vesicles in patient with HZV infection.

  • Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Shingles on waist

    Shingles on waist

  • Dermatomal involvement of rash

    Dermatomal involvement of rash

  • Dermatomal involvement of skin rash

    Dermatomal involvement of skin rash

  • Herpes zoster on the chest

    Herpes zoster on the chest

  • Varicella zoster

    Varicella zoster

  • Herpes Zoster. (Courtesy of Josh Fierer, M.D. and Charlie Goldberg, M.D.)

    Herpes Zoster.
    (Courtesy of Josh Fierer, M.D. and Charlie Goldberg, M.D.)

  • Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Shingles on face

    Shingles on face

  • Shingles on face

    Shingles on face

  • This 1968 image depicted a number of varicella, or chickenpox lesions on a patient’s back, which were displaying the characteristic “cropping” distribution, or manifesting themselves in clusters, each in a different developmental stage.

    This 1968 image depicted a number of varicella, or chickenpox lesions on a patient’s back, which were displaying the characteristic “cropping” distribution, or manifesting themselves in clusters, each in a different developmental stage.

  • This patient presented with what was differentially diagnosed as a herpes zoster outbreak in order to rule out syphilis.

    This patient presented with what was differentially diagnosed as a herpes zoster outbreak in order to rule out syphilis.

  • This skin disorder was found to be herpes zoster, not syphilitic in nature as was initially suspected.

    This skin disorder was found to be herpes zoster, not syphilitic in nature as was initially suspected.

  • These skin lesions on the forehead of an elderly woman are due to the herpes zoster virus on the 21st day of the illness.

    These skin lesions on the forehead of an elderly woman are due to the herpes zoster virus on the 21st day of the illness.

  • A case of shingles that demonstrates the typical dermatomal distribution, in this case C8/T1

    A case of shingles that demonstrates the typical dermatomal distribution, in this case C8/T1

Head
Trunk
Extremities
Neck
Genitourinary System
Skin

(Images shown below courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

  • Herpes Zoster: Coalesced vesicles resulting from reactivation of HZV infection.

    Herpes Zoster: Coalesced vesicles resulting from reactivation of HZV infection.

  • Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Herpes Zoster: Dermatomally distributed vesicles in patient with HZV infection.

    Herpes Zoster: Dermatomally distributed vesicles in patient with HZV infection.

  • Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Shingles on waist

    Shingles on waist

  • Dermatomal involvement of rash

    Dermatomal involvement of rash

  • Dermatomal involvement of skin rash

    Dermatomal involvement of skin rash

  • Herpes zoster on the chest

    Herpes zoster on the chest

  • Varicella zoster

    Varicella zoster

  • Herpes Zoster. (Courtesy of Josh Fierer, M.D. and Charlie Goldberg, M.D.)

    Herpes Zoster.
    (Courtesy of Josh Fierer, M.D. and Charlie Goldberg, M.D.)

  • Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

    Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.

  • Shingles on face

    Shingles on face

  • Shingles on face

    Shingles on face

  • This 1968 image depicted a number of varicella, or chickenpox lesions on a patient’s back, which were displaying the characteristic “cropping” distribution, or manifesting themselves in clusters, each in a different developmental stage.

    This 1968 image depicted a number of varicella, or chickenpox lesions on a patient’s back, which were displaying the characteristic “cropping” distribution, or manifesting themselves in clusters, each in a different developmental stage.

  • This patient presented with what was differentially diagnosed as a herpes zoster outbreak in order to rule out syphilis.

    This patient presented with what was differentially diagnosed as a herpes zoster outbreak in order to rule out syphilis.

  • This skin disorder was found to be herpes zoster, not syphilitic in nature as was initially suspected.

    This skin disorder was found to be herpes zoster, not syphilitic in nature as was initially suspected.

  • These skin lesions on the forehead of an elderly woman are due to the herpes zoster virus on the 21st day of the illness.

    These skin lesions on the forehead of an elderly woman are due to the herpes zoster virus on the 21st day of the illness.

  • A case of shingles that demonstrates the typical dermatomal distribution, in this case C8/T1

    A case of shingles that demonstrates the typical dermatomal distribution, in this case C8/T1

Gallery

References

  1. ↑ Cohen KR, Salbu RL, Frank J, Israel I (2013). "Presentation and management of herpes zoster (shingles) in the geriatric population". P T. 38 (4): 217–27. PMC 3684190. PMID 23785227.
  2. ↑ Cohen JI, Brunell PA, Straus SE, Krause PR (1999). "Recent advances in varicella-zoster virus infection". Ann. Intern. Med. 130 (11): 922–32. PMID 10375341.
  3. ↑ 3.0 3.1 "Public Health Image Library (PHIL)".


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