key: cord-0980214-7zfhcrv6
authors: Veraldi, Stefano; Marletta, Dario A.; Wei, Yiran; Beretta, Andrea E.
title: Herpes zoster duplex following COVID‐19
date: 2021-11-18
journal: Int J Dermatol
DOI: 10.1111/ijd.15978
sha: 66767b3aae1de52075f47c8931c557c8efaa8e45
doc_id: 980214
cord_uid: 7zfhcrv6

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sis of HZD was based on clinical picture (erythematous-vesicular-pustular and painful rash along two bilateral, asymmetric dermatomes) and cytological examination (the presence of multinucleated giant cells with ballooning degeneration and multiple nuclei, with different shape and size) (Fig. 3 According to the previously cited Chinese study, immunosuppression caused by concomitant diseases or drugs is present in 47.2% of patients. 2 These data mean that HZD occurs also in immunocompetent subjects. 4 Herpes zoster duplex can be mono-or bilateral, symmetric or asymmetric. The bilateral asymmetric presentation is more frequent. Herpes zoster duplex is characterized by typical features: the first lesions are erythema and edema, from pink to red in color, followed by the appearance of grouped, round, small vesicles, with a clear serous fluid. Vesicles evolve toward pustules or erosions that become yellow-brown crusts. The latter drop off, leaving brownish macules that can persist for weeks or months.

However, cases of hemorrhagic, chronic, and recurrent HZD have been described. Sometimes, a clinical diagnosis of HZD must be confirmed by cytologic, histopathologic, and PCR examinations.

As far as complications are concerned, a case of oculomotor nerve palsy was reported. The development of scars is rare and occurs in immunosuppressed patients. However, scars can also occur: a) when there is a delay in the beginning of the therapy; b) when the daily dosage of antivirals is too low; c) when the duration of the therapy is too short.

The therapy of HZD is based on the use of oral acyclovir, valacyclovir, or brivudine. As previously mentioned, in this patient we successfully used valacyclovir (3 g/day for 7 days).

To our knowledge, no cases of HZD in patients with previous COVID-19 have been published so far. In our patient, immunosuppressive diseases or drugs cannot be considered as predisposing factors for the occurrence of HZD. However, in patients with previous COVID-19, HZ often develops 8-10 weeks after COVID-19 recovery: this is because of a reactivation of latent VZV infection. 5 In our patient, the appearance of HZD can be because of chronic lymphopenia after COVID-19 recovery. 

Pathogenese und Therapie des Herpes Zoster, insbesondere zur H€ aufigkeit des Zoster duplex unilateralis

Zoster duplex: a clinical report and etiologic analysis

Herpes zoster duplex bilateralis in an immunocompetent adolescent boy: a case report and literature review

Herpes zoster duplex bilateralis symmetricus in an immunocompetent subject

Herpes zoster following COVID-19: a report of three cases

Funding source: None. doi: 10.1111/ijd.15978