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A 10-year-old boy is brought by his mother for evaluation of persistent “acne” that started when the boy was a baby. Herpes simplex virus infection (B) should always a consideration in a newborn with a vesicular lesion, with an estimated 1,500 cases in the U.S.
This image displays grouped blisters within an inflamed area of skin typical of herpes simplex.
Herpes infections are caused by both herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
Although children with mild recurrent herpes do not usually need any medical care, see your pediatrician if you think your child has primary herpes or if your child has recurrent herpes with more severe symptoms. This Site and third parties who place advertisements on this Site may collect and use information about your visits to this Site and other websites in order to provide advertisements about goods and services of interest to you. If you would like to obtain more information about these advertising practices and to make choices about online behavioral advertising, please click here. The varicella zoster virus is a type of herpes simplex virus (HSV) but is not the same as the herpes simplex virus that causes genital herpes. Herpes zoster is not a virus but a syndrome that arises with reactivation of the varicella zoster virus (VZV) years or even decades after chickenpox.
Herpes zoster is the same as shingles, an alternative and commonly used name for this condition.
Herpes zoster is more likely to occur in a person with a depressed immune system and the elderly.
Herpes zoster, commonly known as just zoster or shingles, is a condition caused by the reactivation of the varicella zoster virus (VZV). Shingles is the syndrome where a painful skin rash marked by the presence of tiny blisters usually forms on a dermarcated area on the skin surface of the head or trunk. Once the virus reactivates, it causes inflammation of the nerves and is therefore also known as acute posterior ganglionitis. However, shingles often arises for no known reason even in a person without any of these contributing factors. Images from CDC (1)The main symptoms of herpes zoster (shingles) is an itchy skin rash and pain which has been discussed in detail below.
Herpes zoster mainly affects sensory nerves but motor nerves that control muscles may also be affected.


Pain that lasts for longer than a month, even after the rash clears, is most likely a complication of shingles known as post-herpetic neuralgia.
All images have been sourced from the Dermatology Atlas (2) courtesy of Samuel Freire da Silva, M.D.
Tricyclic antidepressants, anticonvulsants and corticosteroids along with anesthetics may be needed for post-herpetic neuralgia. Treatment should be commenced immediately once a diagnosis of shingles is made, preferably within the first few days of the onset of the rash. Zoster vaccine to prevent shingles and should be considered only for a person older than 60 years of age.
Ask a Doctor Online Now!Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. Encourage your child to drink as much fluid (milk, water, or juice) as possible to avoid dehydration. After the active phase of the infection resolves, the virus stays dormant at the spinal nerve root, specifically the dorsal root ganglion. It mainly affects the sensory nerves but can sometimes involve the motor nerves – those nerves that control muscles in the body. These symptoms usually settle after 10 to 15 days but can take up to one month to resolve completely.
This gives rise to symptoms such as paralysis of the diaphragm, bladder and bowel problems, cranial nerve palsies and muscle weakness. A dermatome is an area of the skin which is innervated by nerves from a single spinal root. However, if the infection occurs in a vaccinated person it is usually less severe and shorter in duration.
Shingles can affect any age group but is more commonly seen in the elderly and those with depressed immune defenses.
Although the peripheral nerves to the trunk is commonly affected, the virus may cause inflammation of any part of the nervous system, even the brain (encephalitis), meninges (meningitis) or both (meningoencephalitis). The virus is able to enter the brain and spinal fluid and can cause seizures and even death.
The varicella zoster virus causes the common childhood infection known as chickenpox which resolves after a few weeks.


The virus targets certain nerves with symptoms such as the rash and pain being isolated to those areas of the skin supplied by a single spinal nerve. However, the virus remains dormant for long periods of time in the body and may sometimes reactivate to cause inflammation of the nerve roots. Although shingles resolves within a month, it can sometimes lead to complications or the pain can persist for months thereafter (post-herpetic neuralgia). About a week before presentation, the child fell with his right hand outstretched onto broken glass.
These infections are far less severe in nature and usually result in only sores on the mouth or lips of the infant.
This does not happen in every person who had chickenpox and is more frequently seen in diminished immune states.
Vaccines provide an effective albeit not guaranteed protection against developing shingles.
The erythema on the proximal index finger and the narrow linear abrasion distal to the pustules were remnants of that injury. Grouped vesicles or pustules on an erythematous base are characteristic of herpes simplex dermatitis. Symptoms, when present, may include pain, headache, tender lymphadenopathy, fever, and malaise. The mild trauma to the right hand could have been a trigger for the eruption in this child. HSV-1 infections can be diagnosed clinically; however, an HSV culture or DNA test may be necessary for confirmation. In this case, culture of one of the pustules was positive for HSV-1, and the diagnosis was confirmed by direct immunofluorescence. For mild primary HSV-1 infection in children, antiviral agents are not used as first-line treatment; however, an antibiotic can be given because of the potential for secondary bacterial infection.



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