From the Guidelines
Multidermatomal varicella zoster shingles presents as a severe and potentially debilitating condition, characterized by a painful rash affecting multiple adjacent dermatomes, with a higher risk of complications and poorer outcomes in immunocompromised individuals, emphasizing the need for prompt antiviral treatment and pain management. The presentation of multidermatomal varicella zoster shingles is distinct from typical shingles, with the rash beginning as erythematous macules and papules that rapidly evolve into grouped vesicles on an erythematous base, distributed across two or more adjacent dermatome regions 1. Patients typically experience prodromal symptoms 1-5 days before the rash appears, including pain, burning, tingling, or itching in the affected areas, which can be severe and may be accompanied by fever, headache, malaise, and regional lymphadenopathy. Some key features of multidermatomal varicella zoster shingles include:
- A painful rash affecting multiple adjacent dermatomes
- Higher risk of complications, such as dissemination and secondary bacterial or fungal superinfections, particularly in immunocompromised individuals 1
- Potential for chronic ulcerations with persistent viral replication if left untreated or inadequately treated
- Need for prompt antiviral treatment, such as high-dose IV acyclovir, oral acyclovir, famciclovir, or valacyclovir, to reduce the risk of complications and improve outcomes 1
- Importance of pain management, often requiring a combination of analgesics, anticonvulsants, or tricyclic antidepressants for neuropathic pain. The involvement of multiple dermatomes signals a more extensive viral reactivation and may indicate underlying immunosuppression that warrants investigation if not already known, highlighting the importance of a thorough medical evaluation and prompt treatment to prevent long-term sequelae and improve quality of life 1.
From the Research
Presentation of Multidermatomal Varicella Zoster Shingles
- Multidermatomal varicella zoster shingles is a rare dermatological manifestation characterized by a rash spread over two or more adjacent dermatomes 2.
- It can present with atypical manifestations, making diagnosis challenging 2.
- The condition is usually linked to immunocompromised individuals, but it can also occur in immunocompetent adults 2.
- Symptoms may include low-grade fever, sore throat, and an uncomfortable pruritic erythematous rash 2.
Clinical Features
- The rash can be exudative and may crust over time 2.
- Patients may experience increasing pain and discomfort 2.
- The condition can be misdiagnosed as an allergic reaction or other dermatological conditions 2.
- A biopsy may be necessary to confirm the diagnosis of multidermatomal herpes zoster 2.
Treatment
- Antiviral treatment, such as valacyclovir, can be effective in managing multidermatomal herpes zoster 3, 4, 5.
- Combination therapy with valacyclovir, methylprednisolone, and pregabalin may have better efficacy in reducing acute pain and postherpetic neuralgia 4.
- Treatment should be started as soon as possible after symptoms appear to maximize efficacy 3.