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Herpes zoster is a viral infection characterised by unilateral grouped vesicular eruption caused by varicella zoster virus. It occurs because of reactivation of the latent virus in the sensory root ganglion. This article aims to study the incidence, clinical profile, precipitating factors, type of dermatomal involvement and clinical variations of herpes zoster along with its association with HIV infection. The study was done at VS Hospital, Ahmedabad and total of 120 patients (72 male and 48 females) were included in the study. All patients (of all ages) diagnosed clinically as herpes zoster and confirmed by Tzanck smear were included in the study. Data related to demographic profile, clinical profile and complications of herpes zoster was collected and analysed. All patients were also screened for HIV and other comorbidities. Most patients presented with vesicular lesions and the most common prodrome was burning sensation. Thoracic ganglion was most commonly involved. The most frequent complications were post herpetic neuralgia and dyspigmentation. Nineteen of our patients had multidermatomal involvement. Twenty of 120 patients (16.6%) of herpes zoster were HIV positive. Twelve of 120 patients were below 12 years of age. The chances of post herpetic neuralgia increased when treatment was initiated late. This study helped analyse the varied clinical presentations and complications of herpes zoster. Herpes zoster serves as an important early marker for HIV infection. Interesting change in trend was noticed in the demography of herpes zoster and its relatively high incidence in the paediatric age group

Herpes zoster is an infection that develops when varicella-zoster virus reactivates from its latent state in a nerve ganglion. Symptoms typically begin with pain along the affected dermatome, followed within 2-3 days by a vesicular eruption, which is usually diagnostic. Herpes zoster eruption involving 2 disparate dermatomes on different sides of the body is referred to as herpes zoster duplex bilateralis, with a reported occurrence rate of < 0.5% when compared with general herpes zoster.1 Multidermatomal herpes zoster has been most commonly reported in immunocompromised individuals. In a comprehensive literature review by Vu. et al conducted between 1969 and 1999, 6 cases of multidermatomal herpes zoster were reported, with only one of these 6 cases presenting in an immunocompetent adult.2,3 Atypical herpes zoster has been reported in the immunocompetent elderly, suggesting a general immunocompromised state of advanced age with no evident underlying immunocompromised condition.4 The classic clinical presentation consists of clear vesicles in a dermatomal distribution; however, a hemorrhagic or purpuric presentation has been reported in association with anticoagulants, in particular clopidogrel.5

We report a case of linear IgA bullous dermatosis, a rare autoimmune blistering disorder that usually presents with the abrupt onset of tense bullae. We also emphasize the importance of direct immunofluorescence for the definitive diagnosis.

Thermal burn injuries are a known complication of forced-air warming devices but rarely occur when the device is used in accordance with the manufacturer’s instructions. Here we present a case of a 3-year-old girl who in the immediate postoperative period was found to have prominent linear, evenly spaced vesicles and bullae in a pattern that distinctly matched the air-exit perforations of the Bair Hugger device. Clinicians should be aware of potential complications arising from even proper use of a medical device and take all necessary precautions to prevent such incidents.

Majority of the patients in this study were in the age group of 20 -40. The mode of transmission in most of the cases was Trans sexual. In this study group, the previously diagnosed HIV positive cases were screened within one year of detection. Majority of the patients in this study were asymptomatic. 41.33 patients were symptomatic with defective vision being the most common complaint. Vesicular eruptions with pain were the next common complaint in patients with HZO. A clinical diagnosis of CMV retinitis was made in three patients who presented who presented with bilateral loss of vision. Out of the 74 cases screened, 40 patients had ocular involvement (53.3%) The most common manifestation was non-infectious HIV retinopathy seen 1n 14 patients (18.67%).

Dyshidrotic eczema (DE) or acute palmoplantar eczema is a common cause of hand and foot dermatitis in adults. It is a recurrent vesicular eruption affecting the soles, palms, or both. It is very pruriginous and generally appears suddenly. It creates vesicles that, on physical examination, can look similar to "tapioca pudding", which is the characteristic clinical feature of this disorder. It is more common in young adults and affects men and women equally. In this report, we present the case of a 56-year-old man with no relevant past medical history who presented to the hospital with vesicular lesions in his hands and maculopapular lesions in his arms and legs. The patient had characteristic lesions in his right hand consistent with DE and negative workup for bullous pemphigoid, scabies, and bacterial, fungal, and viral infections.

We read with interest the classification of cutaneous manifestations in Coronavirus disease 19 (COVID-19) by C Galvan Casas et al (1) In particular, vesicular eruptions are characterized as monomorphic vesicles, involving the trunk, happening early in the course of the disease, and occasionally preceding other symptoms(1-3) However, investigations to exclude other causes of widespread vesicular eruption, in particular, varicella, were absent In our clinical experience to date, we have had four patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting with vesicular eruptions, which were subsequently confirmed to be true varicella with microbiological and serological investigations

We read with interest the classification of cutaneous manifestations in Coronavirus disease 19 (COVID‐19) by C. Galván Casas et al.1 In particular, vesicular eruptions are characterized as monomorphic vesicles, involving the trunk, happening early in the course of the disease, and occasionally preceding other symptoms1‐3. However, investigations to exclude other causes of widespread vesicular eruption, in particular, varicella, were absent. In our clinical experience to date, we have had four patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection presenting with vesicular eruptions, which were subsequently confirmed to be true varicella with microbiological and serological investigations.

A Caucasian woman aged 18 years developed a well-defined erythematous vesicular eruption with clear non-purulent exudates on the ear lobules and adjacent inferior neck area (Figure 1). Both of her ears had been pierced two weeks earlier at an accredited piercing salon. This was her first piercing. She had been diligent with her care of the new piercings and had used an antiseptic spray given to her by the salon staff to apply to the area. She was otherwise medically well with no personal or family history of skin disease or atopy, and she was not taking any regular medications. The patient initially self-treated the rash by switching to another brand of antiseptic spray from a local pharmacy, which only exacerbated the eruption. The patient was then prescribed oral cephalexin 250 mg and mupirocin 2% ointment for a diagnosis of a suspected wound infection. The patient was also instructed to continue using the antiseptic spray and leave the earrings in. Both antiseptic sprays contained benzalkonium chloride as the main ingredient. There was no response to antibiotic therapy. Ultimately, the patient stopped using the antiseptic spray because of the stinging sensation when applied. Cessation of the antiseptic sprays brought significant improvement. The vesiculation and erythema drastically improved only three days after stopping the sprays (Figure 2).

Dermatitis herpetiformis is a cutaneous manifestation of celiac disease that classically presents as a symmetric pruritic vesicular eruption on extensor surfaces. Typical locations include elbows, knees, and buttocks. Facial involvement has been reported rarely. Here, we report a case of a 44-year-old woman with dermatitis herpetiformis presenting as pruritic vesicles on the face that had previously been misdiagnosed as allergic contact dermatitis. Diagnosis was confirmed with direct immunofluorescence demonstrating granular IgA in the papillary dermis. This eruption cleared with topical dapsone 5% gel and a gluten-free diet. We report this case to raise awareness of facial involvement in dermatitis herpetiformis as well as the possibility of topical dapsone as a therapeutic option.

Background: Radiotherapy-induced acute skin reactions are common and an expected effect of radiotherapy. Eczematous eruptions, however, are rarely reported, with disseminated eczema in particular being infrequently seen and likely underrecognized. Objective: We present a unique case of disseminated vesicular eczema following radiotherapy for ductal carcinoma in situ. Conclusions: The development of a localized vesicular eruption with subsequent dissemination can occur following radiotherapy. The mechanism of autosensitization is poorly understood but likely involves a cell-mediated immune response. Recognition is important to prevent excessive and inappropriate investigation and treatment.

Herpes zoster classically presents as a vesicular eruption along a single dermatome that correlates with the dorsal root ganglion in which varicella zoster virus (VZV) reactivates. Such cases most commonly involve a single thoracic dermatome, but other rare presentations of herpes zoster have been reported including multidermatomal herpes zoster. This letter reports a case of multidermatomal herpes zoster affecting cervical dermatomes C2-C5 and presents all previously published cases of multidermatomal herpes zoster in which involved dermatomes were reported to determine if this condition has a predilection for cervical dermatomes. A total of eight other cases were reviewed and involvement of cervical dermatomes was observed in 6 of 9 cases (66.7%). This suggests a propensity for multidermatomal involvement to affect cervical dermatomes beyond that encountered in classic herpes zoster. Clinicians should be aware of this presentation of herpes zoster especially in the head and neck region where the classic vesicular eruption may not be confined to a single dermatome.

Le zona est une dermatose virale qui peut intéresser n'importe quelle partie du corps. La plus part des personnes atteintes d'un zona ont entre 50 à 70 ans. Toutefois son apparition chez le sujet jeune doit fait rechercher une immunodépression à VIH. Nous rapportons un cas atypique de zona révélant l'infection à VIH chez une patiente de 25 ans présentant une éruption vésiculeuse, douloureuse reposant sur un fond érythémateux localisé sur la plante du pied gauche. Le diagnostic du zona a été évoqué grâce aux éléments cliniques et réconforté par le cytodiagnostic et l'histologie. Cette localisation atypique nous a incités à demander une sérologie à VIH qui est revenue positive.

The reactivation of the Varicella-zoster virus (VZV) is a rare cause of acute gastritis in adults. About 30 cases have been reported in the literature, mostly with immunocompromised patients and mainly after bone marrow transplantation or during the development of malignant hematological diseases. Clinically, it is usually accompanied by cutaneous manifestations. Here, we studied a case of VZV gastritis in a liver transplant (LT) patient. We described the main symptoms, endoscopic findings, histologic changes, and treatment of VZV gastritis. Till now, no case of acute gastritis due to the reactivation of VZV after solid organ transplantation had been reported [2–5]. This was the first reported case of acute gastritis by the reactivation of VZV after LT without cutaneous vesicular eruption. Gastrointestinal symptoms usually develop a week before the onset of fever and cutaneous manifestations. However, in some cases, like this one, vesicular rashes may be absent, making the diagnosis quite challenging. In conclusion, through this case, we suggest including VZV gastritis in the differential diagnosis of gastrointestinal symptoms after transplantation and informing about the response of VZV gastritis to treatment with oral acyclovir.

Ramsay-Hunt syndrome presents with a vesicular eruption in the ear canal or oral cavity associated with ipsilateral peripheral facial paralysis. The cause is reactivation of the herpes zoster virus in the geniculate ganglion. It is the second most frequent cause of non-traumatic peripheral facial paralysis. Acupuncture is a medical procedure endorsed by the WHO with a wide range of indications. It consists of the application of very fine needles in certain points of the body to relieve pain and relieve certain diseases. We present a case of a young woman with unilateral facial paralysis as part of Ramsay Hunt syndrome. She received conventional treatment with acyclovir, analgesics, corticosteroids and eye protection measures 48 h after the onset of symptoms. At three weeks, due to the lack of improvement of the facial paralysis, manual acupuncture was started along with electroacupuncture, plum blossom hammer for facial stimulation and Chinese herbal medicine. An almost complete improvement was obtained at 14 weeks since the onset of the condition. Acupuncture and related techniques may be an effective intervention for this type of condition, and are associated with very few adverse effects.

Varicella zoster virus (VZV) is a DNA virus in the herpesvirus family which manifests with a generalized vesicular eruption (primary varicella, chickenpox) or painful unilateral vesicles confined to a dermatome (dermatomal zoster, herpes zoster, shingles).

Herpes zoster is an acute viral infection characterized by painful dermatomal vesicular eruption on an erythematous base. It results from reactivation of latent varicella zoster virus infection that has persisted in dorsal root ganglia. The disease is commonly encountered in elderly and immunocompromised patients. In the current report, we have presented a 70-year-old woman who developed herpes zoster infection on her left subpectoral-dorsal site following uncomplicated cataract surgery. The patient was consulted with dermatology clinic and treated successfully.

Herpes zoster is the clinical consequence of a late reactivation of the varicella zoster virus. It infects mainly the elderly, pediatric cases are uncommon, usually observed in immunocompromised children. We report an unusual clinical presentation of disseminated cutaneous herpes zoster in immunocompetent infant without history of chickenpox but with positive history of maternal varicella during pregnancy. A 22-month-old male infant was addressed to our department because of a history of crops of vesicular eruption on the thoracic area. This infant did not have a history of postnatal varicella, and his mother had acquired varicella infection during the 8th month of pregnancy. Physical examination showed many crops of vesicular lesions grouped on the left scapular area with some disseminated vesicular lesions present on the trunk and the four extremities. Intravenous acyclovir was administrated with total recovery 10 days later. Disseminated cutaneous varicella zoster virus in infancy is exceptional; few cases were reported in the literature. The dissemination is rare in healthy patients; it is more common in immunocompromised patients and likely to be complicated with visceral or neurologic involvement, but in healthy patients, the course is usually benign and not associated with high morbidity as in our case.

Post Herpetic Neuralgia (PHN) is often diagnosed when pain persists in a dermatomal pattern weeks after the herpes zoster vesicular eruption has healed. There is a definite tendency for PHN to improve with time. There is no way of predicting who will recover. However, some reported that as many as 40% of patients with PHN will continue to have long-term problems because of incomplete or no pain despite the best treatments given. This retrospective series discussed the outcome of treatment of 3 patients with PHN, using acyclovir, Gabapentin and analgesics. Patients were treated by a single pain specialist in a conventional community pain practice. Therapies were given twice-monthly for 1-2 months, then less frequently until pain relief was optimized. Patients received a median of 7 treatments (range 4 - 11). Median baseline allodynia levels were reduced from 9 /10 (range 8 to 10) to 0/10 (range 0 to 6), intermittent shooting pain from 9/10 (range 8 to 10) to 0/10 (range 0 to 6). 1 of 3 patients (30%) was able to be weaned off pain medications. These data showed that there is variation in the response to treatment in patients suffering from PHN. The response ranged from a complete cure to unresponsive at all to the treatment given. There is no way of predicting who will fully recover.

Background and Objective : Dyshidrotic Eczema is characterized by a pruritic vesicular eruption on the fingers, palms, and soles. It is an acute, chronic, or recurrent dermato sis. The causes of dyshidrosis are unknown. There are many treatments available for dyshidrosis including topical steroids but long term treatment of streoids may have side effects. The purpose of this study is to find out the effect of Fulinggancao-Tang on Dyshidrotic Eczema.Methods : We have diagnosed the patients through the Shanghanlu n six meridian patterns diagnostic system and we treated the patients with Fulinggancao-Tang. The severity o f Dyshidrotic Eczema was evaluated by visual analogue scale(VAS). Results : After the treatment itching and vesicles of hands and foots were all disappeared in both patients. Conclusions : Fulinggancao-Tang have improved the signs and symptoms of Dyshidrotic Eczema case. It is considered that Fulinggancao-Tang is considerably effective on the treatment of skin disease that especially vulnerable to water.Keywords;Dyshidrotic Eczema(汗疱疹); Fulinggancao-Tang(茯苓甘草湯); Shanghanlun(傷寒論); Six meridian patterns(六經診斷)

Ocular motor cranial nerve palsies of viral etiology are uncommon and, when accompanied by skin lesions, zoster ophthalmicus is the most frequent diagnosis. We describe the case of a 68-year-old woman who developed fourth and sixth nerve palsies 3 days after appearance of a painful vesicular skin rash on the left side of her forehead. Neuroimaging was normal but polymerase chain reaction (PCR) testing of the cerebrospinal fluid was positive for Herpes Simplex 1 and negative for Varicella Zoster. The patient was treated with intravenous acyclovir, and the cranial nerve palsies resolved over 7 weeks. Although the similarity of the cutaneous vesicular eruption in our patient to that seen with zoster might have led to an incorrect diagnosis, acyclovir seems to be safe and effective for both viral etiologies.

Background Vesicular rashes are associated with a variety of infectious and noninfectious causes. Objective To discuss the differential diagnoses of vesicular rashes. Methods We present the clinical case of an adult woman who was immunocompetent and who developed several clear fluid-filled vesicles on her upper extremity within days of receiving the varicella zoster vaccine. Over the next several days, the skin eruption generalized, and she developed new lesions in various stages of healing. Results After a detailed history and further studies were obtained, a final diagnosis was made. Conclusion In patients who have recently been vaccinated, a high index of suspicion for an adverse vaccine reaction should be maintained.

Erythema annulare centrifugum (EAC) presents as erythematous or urticarial papules, each with an annular shape, that exhibit peripheral extension. Internal malignancies are occasionally associated with EAC, and infectious diseases, including fungal, bacterial or viral infections, have also been regarded as possible causes of EAC. A 35-year-old man had a 1-week history of a painful vesicular eruption over the trunk corresponding to dermatomes Th8-10. Concomitantly, he developed several annular eruptions over the trunk. We diagnosed the former lesions as herpes zoster and the latter as EAC associated with herpes zoster. Although DNA was extracted from the EAC region, no varicella-zoster virus DNA was detected. We consider that this is Wolf's isotopic response, which is caused by an alteration of the local immunity due to viral infection. An etiologic relationship between EAC and herpes zoster is strongly suggested by the present case and by our review.

We present two cases of herpes zoster related orbital inflammatory syndrome that preceded the development of the cutaneous vesicular eruption. These cases demonstrate that patients with presumed idiopathic orbital inflammatory syndrome should be warned about the development of herpes zoster and should be specifically evaluated for the cutaneous vesicular eruption of herpes zoster ophthalmicus and antiviral treatment initiated, if indicated.

What's your diagnosis (figure 1)? The answer is on the next pageAnswer to sQUIZ: Linear immunoglobulin A dermatosisBiopsy of the lesion showed a superficial, dermal, predominantly neutrophilic infiltrate located mainly in the dermal papillae, with the formation of subepidermal blisters. A direct immunofluorescence (DIF) analysis of the perilesional skin revealed linear immunoglobulin A (IgA) deposits in the basement membrane zone. On the basis of the clinical presentation, histopathological and DIF [...]

Eosinophilic dermatosis of hematologic malignancy is a rare, paraneoplastic phenomenon that presents as a pruritic papular or vesicular eruption that is clinically and histopathologically similar to insect bites. We present a 56-year-old man with multiple relapses of diffuse large B cell lymphoma with a typical presentation of pruritic papules and vesicles on the extremities that correlate with a recent relapse of his lymphoma.

A previously healthy 69-year-old man presents to his primary care physician with a painful vesicular eruption of 24 hours’ duration. He recalls that his 65-year-old brother had a similar rash one year earlier, which had been diagnosed as shingles. He wants to know what can be done to prevent the

A previously healthy eight-month-old female Chinese infant presented with hyperpigmented swirly patches over the abdomen and legs for the past two months. Two weeks before her visit, the infant developed a vesicular eruption within the hyperpigmented streaks, which the mother photographed (Figure 1). This eruption coincided with a febrile upper respiratory tract infection. Figure 1) Vesicles in a linear distribution overlying hyperpigmented streaks Medical history revealed that the patient was born to nonconsanguineous parents following a normal pregnancy and delivery. At birth, she exhibited a vesicular eruption that resolved within the first few weeks of life. This was the family’s first pregnancy, with no history of previous miscarriages. The patient was otherwise healthy, with no history of seizures, developmental delay, delayed dentition or nail abnormalities. No one in the family had similar findings. On examination, the patient appeared well. She had a normal neurological, respiratory, cardiac and abdominal examination. The cutaneous examination revealed multiple hyperpigmented patches over the abdomen and legs in a swirled pattern along Blashko’s lines (Figure 2). There were no residual vesicles or other cutaneous changes, and no nail dystrophy. Figure 2) Hyperpigmented swirly patches following the lines of Blashcko on the trunk The hyperpigmented streaks, the recent vesicular eruption and photographs from birth confirmed the diagnosis.

Three cases of Langerhans' cell histiocytosis with unusual clinical and histopathologic features are described. The first two cases illustrate diagnostic pitfalls that underscore the importance of considering Langerhans' cell histiocytosis in the differential diagnosis of purpuric papular eruptions of the scalp and intertriginous areas, particularly in association with hypothalamic, pituitary, or liver disease. The third case is the first report of Langerhans' cell histiocytosis presenting as a vesicular eruption.

A previously well 8-year-old girl presented with a florid inflammatory eruption affecting her face and arms. She had initially noticed a linear erythematous lesion on her left cheek. This progressed over 24 h into an itchy vesicular eruption with severe periorbital oedema. A clinical diagnosis of impetigo was made in the absence of any initial history of contact exposure. …

A 25-year-old man with Crohn's disease that was well controlled with infliximab presented with a vesicular eruption that had affected his right great toe for 3 months. Ascending pink, painful nodules, which exuded yellow fluid, developed on his right leg.