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Signs herpes outbreak is coming

Sir,A 63-year-old male presented with asymptomatic skin lesions at the site of healed herpes zoster on left side of chest and back for the previous 3 weeks. A Awaad,AA Seleem Biotechnic & Histochemistry. If herpes zoster involves the sensory portion of the geniculate ganglion of the facial nerve, it may produce a lower motor neuron facial paralysis.
He had been treated 2 months earlier for herpes zoster at the same site with oral acyclovir tablets, topical acyclovir cream, and tablet diclofenac sodium 50 mg twice daily. Acquired reactive perforating collagenosis: Unilateral umbilicated papules along the lesions of herpes zoster.
Two cases of reactive perforating collagenosis arising at the site of healed herpes zoster. Wolf's isotopic response- lichen planus at the site of healed herpes zoster in an Indian woman. Acquired reactive perforating collagenosis: four patients with a giant variant treated with allopurinol.
It is mostly contagious in the incubation period of chickenpox which can last from 7 to 23 days.

After the facial nerve, the other cranial nerves most frequently involved in order of decreasing frequency are the eighth, ninth, fifth, tenth, and sixth nerves. Herpes zoster should be distinguished from herpes simplex. Routine hematology and urine examination, blood glucose estimation, urea, serum creatinine, and thyroid functions were normal. Herpes simplex most commonly causes an acute viral vesicular eruption of the skin and mucous membranes, caused by herpesvirus hominis.
Histopathology from a papular lesion and the plaque revealed similar findings with cup-shaped epidermal invagination having parakeratotic stratum corneum and necrotic debris.
The lesions of herpes simplex originate as erythematous papules which develop into a small localized group of vesicles. The diagnosis of herpes simplex can be confirmed by viral culture, since material aspirated from an early vesicle will ,row readily in tissue culture, usually within one to three days. The mildly acanthotic epidermis had perforating channels containing collagen fibers at several places [Figure 2]. Herpes simplex, unlike herpes zoster, is not associated with cranial nerve involvement, and is consequently not confined to specific dermatomes in the head and neck area. This patient developed a temporary and incomplete left facial nerve paralysis as the result of a herpes zoster infection. Masson-Trichrome stain revealed vertically oriented collagen fibers in upper dermis, ready to initiate formation of the perforating channels [Figure 3]. After confirming the diagnosis of reactive perforating collagnosis, topical retinoic acid cream 0.025% was prescribed.

Even though shingles virus is not considered to be a fully contagious disease, people with weak immune system, small children. Wyburn-Mason [3] were the first to report 25 cases manifesting with malignant tumors at the site of healed herpes zoster. The subsequent conditions may be granuloma annulare, Kaposi's sarcoma, metastasis, lymphoma, leukemia cutis, pseudolymphoma, sarcoid, tinea, angiosarcoma, Bowen's disease, tuberculoid, and vasculitic granuloma.
The less frequent conditions are acneiform eruptions, lichen sclerosus et atrophicus, solar degeneration, furunculosis, lichen planus, and reactive perforating collagenosis.
Acneiform eruptions and granuloma annulare appear within a few days, whereas furunculosis, fungal infections, and pseudolymphoma manifest within 1 month of resolution of the primary condition. It was differentiated from porokeratosis of Mibelli by the absence of a raised, ridge-like border with a thin furrow in the center of the ridge, and histopathology.
Detailed studies of more patients with "Wolf's isotopic response" may help in understanding its exact pathomechanism, the reason for localization and causation of some diseases and for the supposed relation if any, between herpes zoster and malignancies, granulomatous disorders, and infections.

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