Herpes Zoster Workup

  • Author: Joseph S Eastern, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 11, 2011
 

Laboratory Studies

Systemic manifestations are uncommon and usually are confined to patients in whom the immune system has been compromised by other disease processes or chemotherapy. General laboratory studies and other systemic workup are not indicated unless complications or underlying diseases are suggested. A small percentage of patients, particularly those with CN involvement, may develop headache and neck stiffness, necessitating a spinal tap to exclude meningitis.

Occasionally, Tzanck preparation, viral culture, direct fluorescence antibody (DFA) testing, and/or skin biopsy may be necessary to establish the diagnosis in atypical cases. DFA testing is more sensitive than conventional viral cultures because of the lability of varicella-zoster virus (VZV).

Zoster is seen approximately 7 times more frequently in patients infected by human immunodeficiency virus (HIV); therefore, when clinically indicated, order an HIV test.

Zoster occasionally is considered a harbinger of other occult disease, particularly malignancies in older patients. Studies in hospitalized populations show an increased incidence of zoster in patients with cancer, particularly those of the lymphoreticular system. However, prospective studies on nonhospitalized patients have not demonstrated any difference in incidence between patients with malignancies and those without. Both zoster and malignancy are common in elderly individuals; therefore, most experts currently consider the association to be purely coincidental.

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Histologic Findings

Clinical diagnosis almost always can be made. Biopsy is reserved for cases difficult to diagnose. On rare occasions when biopsy is necessary, histologic findings are similar to those of herpes simplex and varicella (chickenpox). Ballooning degeneration and acantholysis of keratinocytes result in an intraepidermal vesicle. Multinucleated giant cells with accentuation of nuclear material at the periphery of nuclei are characteristic. Underlying leukocytoclastic vasculitis often is a prominent finding and helps differentiate zoster from other herpetic infections.

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Contributor Information and Disclosures
Author

Joseph S Eastern, MD  Clinical Assistant Professor, Department of Internal Medicine, Section of Dermatology, University of Medicine and Dentistry of New Jersey

Joseph S Eastern, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, International Society for Dermatologic Surgery, and Medical Society of New Jersey

Disclosure: Abbott Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Aqua Honoraria Consulting; Stiefel Honoraria Speaking and teaching; Medicis Honoraria Speaking and teaching; Quinnova Honoraria Consulting; Graceway Speaking and teaching; Abbott Grant/research funds Clinical Research; Amgen Grant/research funds Clinical Research

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Typical zoster in the vicinity of right popliteal fossa in a vertebral nerve L4 distribution.
Suspected zoster of the hand.
 
 
 
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