From the Guidelines
Disseminated herpes zoster is a serious condition where the varicella-zoster virus infection spreads beyond the primary dermatome, affecting multiple areas of the body, typically defined as having 20 or more vesicular lesions outside the primary or adjacent dermatomes, and requires immediate administration of intravenous antiviral medications such as acyclovir, valacyclovir, or famciclovir.
Definition and Diagnosis
Disseminated herpes zoster occurs when the dormant virus from a previous chickenpox infection reactivates and spreads extensively. This condition is most common in immunocompromised individuals, including those with HIV/AIDS, cancer patients undergoing chemotherapy, organ transplant recipients, or those on immunosuppressive medications 1.
Treatment and Management
Treatment typically involves immediate administration of intravenous antiviral medications such as acyclovir (10 mg/kg every 8 hours for 7-10 days), valacyclovir, or famciclovir, and hospitalization is often necessary to monitor for potential complications, which can include pneumonia, hepatitis, encephalitis, and disseminated intravascular coagulation 1.
Key Considerations
The mortality rate is significantly higher than with localized zoster, particularly in severely immunocompromised patients. Early recognition and aggressive treatment are crucial to improve outcomes, and pain management is an important component of care as the condition can be extremely painful.
- Important considerations in the treatment of disseminated herpes zoster include:
- Immediate administration of intravenous antiviral medications
- Hospitalization to monitor for potential complications
- Pain management as an important component of care
- Temporary reduction in the amount of immunosuppressive medication in cases of disseminated or invasive herpes zoster 1
From the Research
Definition of Disseminated Herpes Zoster
Disseminated herpes zoster (DHZ) is a severe form of herpes zoster characterized by:
- Non-dermatomal skin eruptions, often with involvement of other organs
- Occurs in immunocompromised patients, such as those with human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT), and hematopoietic stem cell transplantation (HSCT) 2
- Can cause diffuse rash, encephalitis, hepatitis, and pneumonitis 2, 3
Key Features of Disseminated Herpes Zoster
- Atypical presentation, with diffuse, non-dermatomal, vesicular eruptions 2, 4
- Can occur in immunocompetent adults, although rare 3
- Requires timely diagnosis and initiation of antiviral therapy to minimize morbidity and mortality 2, 4
- Can be fatal, especially in immunocompromised patients with severe disease 4
Diagnosis and Treatment of Disseminated Herpes Zoster
- Diagnosis should be considered in immunosuppressed patients with seizures and skin eruptions 4
- Treatment with antiviral agents, such as acyclovir, valacyclovir, and famciclovir, is effective in reducing morbidity and mortality 5, 6
- Early diagnosis and treatment are critical to prevent complications and improve outcomes 2, 4