Can herpes simplex occur on the thorax?

Herpes Simplex Virus Can Occur on the Thorax

Yes, herpes simplex virus (HSV) can infect the thorax, although this is not its typical presentation site. While HSV most commonly affects oral and genital regions, it can infect virtually any skin or mucosal surface of the body, including the thoracic area 1.

Typical Locations of HSV Infections

HSV infections typically present in specific anatomical locations:

• HSV-1: Primarily causes infections "above the neck" including:

  • Orofacial regions (lips, mouth, face)
  • Oral mucosa (herpes labialis or "cold sores")
  • Eyes (herpetic keratitis) 2

• HSV-2: Typically causes infections "below the waist" including:

  • Genital mucosa
  • Genital skin (penile and labial)
  • Perigenital region 3

Atypical Presentations Including Thoracic Involvement

Despite these typical patterns, both HSV-1 and HSV-2 can infect other body sites:

• HSV can infect "other areas, including the eyes and oro-pharynx and rectal mucosa" 3
• In immunocompromised patients, HSV may cause "local infection with vast skin involvement" beyond the typical sites 1
• HSV can present as a systemic infection affecting multiple body systems, including the thorax 1

Clinical Presentation of HSV on the Thorax

When HSV affects the thoracic area, it typically presents as:

• Grouped vesicles on an erythematous base
• Vesicles that eventually rupture forming shallow ulcers
• Lesions that crust and heal spontaneously without scarring
• Possible pain, tingling, or burning sensation in the affected area 2

Diagnosis of HSV on the Thorax

Diagnosis of HSV on the thorax follows the same principles as other sites:

1. Clinical examination: Identifying characteristic grouped vesicles or ulcers on an erythematous base 2

2. Laboratory confirmation (recommended for atypical presentations):

   • Viral culture (gold standard)
   • Nucleic acid amplification tests (NAATs)
   • Direct fluorescent antibody testing
   • Tzanck test (less sensitive) 3

Management Considerations

Treatment for HSV on the thorax is similar to other sites:

• Oral antiviral medications (acyclovir, valacyclovir, or famciclovir) for primary or severe recurrent episodes
• Topical antivirals may be used but are less effective than oral treatment
• Prompt initiation of treatment is recommended to reduce symptom duration 2

Important Clinical Considerations

1. Differential diagnosis: HSV on the thorax may be confused with:

   • Herpes zoster (shingles)
   • Contact dermatitis
   • Impetigo
   • Other vesicular skin conditions

2. Transmission risk: HSV on the thorax can be transmitted through direct contact with the lesions

3. Recurrence potential: Like other HSV infections, thoracic HSV may recur due to viral latency in sensory ganglia 1

HSV infection of the thorax is an important consideration in patients presenting with grouped vesicular lesions in this area, particularly in immunocompromised individuals who may develop more extensive or atypical presentations.