Herpes Zoster (Shingles)

Bell's palsy. The patient had Lyme disease diagnosed 2 weeks before. Right-sided facial weakness.

Red eye: V1 herpes zoster. A. Vesicles in the V1 distribution. B. Keratitis. Note psuedodendritic uptake of fluorescein.

From Cohen  EJ, Rapuano  CJ, Laibson  PR. External diseases. In: Tasman  W, Jaeger  EA, eds. The Wills Eye Hospital Atlas of Clinical Ophthalmology, 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2001:8, with permission.

B: They stain with fluorescein, but are not ulcerated.

From Tasman  W, Jaeger  E. The Wills Eye Hospital Atlas of Clinical Ophthalmology, 2e. Lippincott Williams & Wilkins, 2001

1.23. A: In overt primary herpes simplex virus infection, there is a vesicular lid rash that usually does not scar.

1.26. B: Nonnecrotizing HSV stromal keratitis is associated with localized corneal edema, which may not have a disciform shape.

Herpes simplex cervicitis.

Rash of varicella on abdomen in pregnant woman.

Rash of varicella: Crops of lesions in various stages (vesicles, pustules, scabs).

Congenital varicella syndrome.

FIG. 11.57. (A, B) Varicella. This patient displays the typical findings in varicella. Lesions occur in different stages. Most characteristic are vesicles and "dewdrops" (2- to 3-mm fine vesicles on a 4- to 5-mm base of erythema).

Varicella: back, child

FIG. 11.57. (A, B) Varicella. This patient displays the typical findings in varicella. Lesions occur in different stages. Most characteristic are vesicles and "dewdrops" (2- to 3-mm fine vesicles on a 4- to 5-mm base of erythema).

FIG. 11.58. Varicella. This child also displays typical lesions.

FIG. 11.61. Varicella pneumonia. Severe pneumonia developed in this patient shortly after she developed vesicular skin lesions that were positive for varicella-zoster virus by direct fluorescent antibody. Varicella causes a diffuse, miliary pattern.

FIG. 15.12. Herpes zoster involving the ophthalmic branch of the trigeminal nerve. The patient presented with 6 days of eye pain and rash that included vesicles on the nose.

Bell palsy: peripheral (lower motor neuro) paralysis of the facial nerve

Herpes simplex: retroauricular

HSV - culture-confirmed. Painful vesicles on the foot.

<bold>Figure 66-3</bold> Breakthrough varicella. Note the "dew-drop-on-a-rose-petal" appearance of this lesion in a child previously immunized against varicella. (Courtesy of Esther K. Chung, MD.)

<bold>Figure 66-4</bold> Varicella. Note the various stages of the lesions: papular, vesicular, and crusted lesions. (Courtesy of Shirley P. Klein, MD.)

Herpes zoster. These umbilicated vesicles of various sizes are grouped on an erythematous base. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Herpes zoster. “Juicy,” erythematous, urticarialike papules are seen here in a “zosteriform” distribution. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Herpes zoster. Drying hemorrhagic crusts appear in a “zosteriform” distribution. In this immunocompromised patient, the lesions will probably heal with scars. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Herpes zoster ophthalmicus. This condition affects the first branch of the fifth cranial nerve. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

FIG. 6.2. Eczema herpeticum. Ulcers and excoriations, as in these two cases [patient 1 (A, B), patient 2 (C)], usually characterize the eruption, although vesicles may be seen at times (D). More severe cases [patient 3 (E), patient 4 (F, G), patient 5 (H)], with generalized eruptions, require intravenous therapy with acyclovir.

FIG. 6.2. Eczema herpeticum. Ulcers and excoriations, as in these two cases [patient 1 (A, B), patient 2 (C)], usually characterize the eruption, although vesicles may be seen at times (D). More severe cases [patient 3 (E), patient 4 (F, G), patient 5 (H)], with generalized eruptions, require intravenous therapy with acyclovir.

FIG. 6.2. Eczema herpeticum. Ulcers and excoriations, as in these two cases [patient 1 (A, B), patient 2 (C)], usually characterize the eruption, although vesicles may be seen at times (D). More severe cases [patient 3 (E), patient 4 (F, G), patient 5 (H)], with generalized eruptions, require intravenous therapy with acyclovir.

1.21. A: The hallmark of herpes simplex keratitis is the dendrite, a branching, epithelial ulceration with swollen, raised edges and terminal bulbs.

Herpes cervicitis.

Herpes simplex eruption on the waist of an RN - present for a few days

FIG. 11.62. Zoster. This child has a mild outbreak of zoster of the chest. The lesions are virtually identical to the exanthem of primary varicella, other than being confined to a single dermatome.

Herpes zoster in a 13 yo with a pruritic eruption for 3 days

Herpes zoster (shingles) in a thoracic dermatome