Herpes zoster differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. [2]

Overview

Diagnosis of Herpes zoster might not be possible in the absence of a rash (i.e., before rash or in cases of zoster without rash). It is sometimes confused with herpes simplex, and, occasionally, with impetigo, contact dermatitis, folliculitis, scabies, insect bites, papular urticaria, candidal infection, dermatitis herpetiformis, and drug eruptions.

Differential Diagnosis

For rash:

• Atopic dermatitis
• Atypical measles
• Coxsackievirus infections
• Pyoderma
• Herpes simplex
• Impetigo
• Contact dermatitis
• Folliculitis
• Scabies
• Insect bites
• Papular urticaria
• Candidal infection
• Dermatitis herpetiformis
• Drug eruptions.

For pain symptoms depending on the location:

• Angina
• Cholecystitis
• Appendicitis
• Trigeminal neuralgia
• Renal calculi
• Glaucoma
• Spinal cord compression

Herpes zoster can be more difficult to diagnose in children, younger adults, and immunocompromised persons who are more likely to have atypical presentations.