Varicella and Herpes Zoster

Etiology • Primary and recurrent forms due to varicella-zoster virus (VZV) • Primary VZV (chickenpox): a childhood exanthem • Secondary (recurrent) VZV (herpes zoster/shingles) infection:
most common in elderly or immunocompromised adults
Clinical Presentation • Varicella (chickenpox)
• Fever, headache, malaise, and pharyngitis with a 2-week incubation
• Skin with widespread vesicular eruption • Oral mucosa with short-lived vesicles that rupture forming
shallow, defined ulcers • Herpes zoster (shingles)
• Unilateral, dermatomal, grouped vesicular eruption of skin and/or oral mucosa

• Vesicles may coalesce prior to ulceration and crusting. • Lesions are painful. • Prodromal symptoms along affected dermatome may occur. • Pain, paresthesia, burning, tingling • Postherpetic pain may be severe.
Diagnosis • Clinical appearance and symptoms • Cytologic smear with cytopathic effect present (multinucleated
giant cells) • Viral culture or PCR examination of blister fluid or scraping
from base of erosion • Serologic evaluation of VZV antibody • Biopsy with direct fluorescent examination using fluorescein-
labeled VZV antibody
Differential Diagnosis • Primary herpes simplex/acute herpetic gingivostomatitis • Recurrent intraoral herpes simplex • Pemphigus vulgaris • Mucous membrane (cicatricial) pemphigoid
Treatment • Symptomatic management in primary infection • Antiviral drugs (especially acyclovir) in immunocompromised
patients or patients with extensive disease • Systemic corticosteroids may be used to help control/prevent
postherpetic neuralgia. • Pain control to prevent “CNS imprinting”
Prognosis • Generally good • Recurrences more likely in immunosuppressed patients