From the Guidelines
No, multidermatomal varicella zoster shingles does not have to involve adjacent dermatomes. While typical shingles (herpes zoster) usually affects a single dermatome in a unilateral distribution, multidermatomal involvement can occur in either contiguous (adjacent) or non-contiguous (separated) dermatomes, as noted in the practice guidelines for the diagnosis and management of skin and soft tissue infections 1. This pattern is more common in immunocompromised patients, such as those with HIV/AIDS, cancer, or those on immunosuppressive medications.
Some key points to consider in the management of multidermatomal varicella zoster shingles include:
- The varicella zoster virus can remain dormant in multiple ganglia after primary chickenpox infection and reactivate in multiple locations simultaneously when immunity wanes 1.
- Immunocompromised patients are at a higher risk of developing severe and disseminated disease, with a 10%–20% risk of developing dissemination without prompt and effective antiviral therapy 1.
- Treatment remains similar to typical shingles, with antiviral medications like acyclovir, valacyclovir, or famciclovir for 7-10 days, though longer courses may be needed in immunocompromised patients 1.
- Pain management with analgesics and early treatment (within 72 hours of rash onset) are important to reduce the risk of postherpetic neuralgia.
It is essential to note that the diagnosis and management of multidermatomal varicella zoster shingles should be guided by the most recent and highest-quality evidence, and treatment should be individualized based on the patient's immune status and disease severity 1.
From the Research
Multidermatomal Varicella Zoster Shingles
- The provided studies do not directly address whether multidermatomal varicella zoster shingles have to be adjacent 2, 3, 4, 5, 6.
- However, the studies suggest that herpes zoster (shingles) is a common disease caused by a reactivation of the latent varicella-zoster virus, which resides in the dorsal root ganglia 3, 4, 5, 6.
- The classic dermatomal rash and pain that occur with herpes zoster are typically limited to a single dermatome, but multidermatomal involvement can occur 2, 5.
- There is no clear evidence to suggest that multidermatomal varicella zoster shingles must be adjacent, but the studies do not provide a definitive answer to this question 2, 3, 4, 5, 6.
Clinical Features and Management
- The clinical features of varicella-zoster virus infection include a dermatomally distributed vesicular rash, pain, and potential complications such as postherpetic neuralgia 4, 5.
- Management of herpes zoster typically involves antiviral medications, such as acyclovir, valacyclovir, or famciclovir, and may also include corticosteroids and pain management medications 3, 4, 6.
- Early treatment is emphasized to reduce the severity of the shingles attack and reduce the incidence of complications 3, 4, 6.