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Pathology of Herpes Zoster (Shingles) caused by Varicella-Zoster Virus

Dr Sampurna Roy MD          


Herpes zoster (shingles) is a recurrent, painful, erythematous vesicular eruption caused by the reactivation of latent varicella-zoster virus in an individual who had chickenpox years earlier.

Adults with shingles may transmit the virus to children and cause chickenpox.

During the latent phase, the virus resides in the dorsal root spinal ganglion or the cranial nerve ganglion.

On reactivation, the virus spreads from the ganglia along sensory nerves to peripheral nerves of the sensory dermatomes.

Attacks of shingles produce cutaneous lesions that resemble varicella.

In shingles, however, the eruptions are limited to one or more sensory dermatomes, and the vesicles or bullae may be few.

Shingles is painful, especially in older people, in contrast to the painless vesicles of children with chickenpox.

Eventually the scales over the vesicles slough, and symptoms remit until another attack.

Visit: Herpes Virus (Herpesviridae); Herpes Simplex Virus Infection

Herpes folliculitis is a rare manifestation of herpes virus infection and it is often misdiagnosed. Diagnostic criteria are not well established, only 24 patients being reported in the literature.

Recently it has been suggested that herpetic folliculitis is more common in infections with varicella zoster virus (VZV) than in those with herpes simplex virus (HSV-1 and -2).

In biopsy specimens taken from herpes virus infections, involvement of follicular units is more commonly encountered in varicella zoster virus infections compared with HSV infections.

Early in the course, herpes folliculitis presents as lymphocytic folliculitis devoid of epithelial changes considered to be diagnostic of herpes virus infections.

Exclusive involvement of follicles is rather typical of zoster.,Herpes folliculitis: clinical, histopathological, and molecular pathologic observations.


Further reading:

Herpes zoster caused by vaccine-strain varicella zoster

Recurrent hemiplegia associated with cerebral vasculopathy following third trimester maternal herpes zoster infection.

Natural history of pain following herpes zoster.

Reactivation of 2 genetically distinct varicella-zoster viruses in the same individual.


Neurological complications of Herpes zoster.

Prevention of shingles by varicella zoster virus vaccination.

Latency of alpha-herpes viruses is accompanied by a chronic inflammation in human trigeminal ganglia but not in dorsal root ganglia.

Varicella zoster virus: out of Africa and into the research laboratory.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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