BACKGROUND: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. OBJECTIVE: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. METHODS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. RESULTS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). CONCLUSION: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes.
Ear ; Earache ; Epidemiology ; Facial Paralysis ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster ; Humans ; Incidence ; Medical Records ; Neuralgia, Postherpetic ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Trigeminal Nerve

No abstract available.
Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Ophthalmoplegia*

PURPOSE: To present a case of orbital inflammation and optic perineuritis preceding vesicular eruption in herpes zoster ophthalmicus(HZO). CASE SUMMARY: An 84-year-old woman with a history of gall bladder cancer and hypertension complained of left periorbital erythematous edema and discomfort. On examination, visual acuity was 20/25 bilaterally; no tenderness, proptosis or ophthalmoplegia was observed. Pupils were equal, round, and reactive to light without relative afferent pupillary defects. Slit-lamp examination revealed severe conjunctival injection and chemosis without keratitis or uveitis. The remainder of the ocular examination was unremarkable. Magnetic resonance imaging confirmed left-sided preseptal swelling with an enlarged left lacrimal gland, high signal intensity of the retrobulbar fat and optic nerve sheath. Systemic antibiotic therapy with steroids was started under a presumed diagnosis of idiopathic orbital inflammatory disease, but the clinical presentation was unresolved. After 2 days, vesicular lesions confined to the first division of the trigeminal nerve and pseudodendritic keratitis developed on the left side leading to a diagnosis of HZO. Treatment with acyclovir immediately resolved anterior segment inflammation and periorbital edema. While on therapy, visual acuity deteriorated to 20/125 and the pupil became dilated and unresponsive to light over a few days. All signs and symptoms of acute orbitopathy and postherpetic neuralgia had resolved 3 months later with the exception of pupil abnormality and visual acuity. CONCLUSIONS: HZO may present with symptoms and signs of orbital inflammation and optic perineuritis even in the absence of a vesicular rash. Thus, HZO should be considered in the differential diagnosis of unexplained acute orbital syndromes.
Acyclovir ; Aged, 80 and over ; Dacryocystitis ; Diagnosis ; Diagnosis, Differential ; Edema ; Exanthema ; Exophthalmos ; Female ; Gallbladder Neoplasms ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Hypertension ; Inflammation* ; Keratitis ; Lacrimal Apparatus ; Magnetic Resonance Imaging ; Neuralgia, Postherpetic ; Ophthalmoplegia ; Optic Nerve ; Orbit* ; Pupil ; Pupil Disorders ; Steroids ; Trigeminal Nerve ; Uveitis ; Visual Acuity

Primary clinical features of rash and neurological complications due to varicella zoster virus (VZV) reactivation are rare in a healthy population, especially in immunocompetent children. Early diagnosis and prompt treatment are delayed often due to their rarity. We present four immunocompetent children with VZV reactivation resulting in aseptic meningitis and herpes zoster affecting multiple cranial and spinal nerves. We reviewed the clinical manifestations, laboratory findings, treatment options and outcome of aseptic meningitis associated VZV reactivation. All patients presented with the typical skin lesion of VZV reactivation and definitive laboratory findings of central nervous system infection, without systemic inflammation. Initial manifestations of VZV reactivation included Ramsay Hunt syndrome, herpes zoster ophthalmicus, and herpes zoster affecting the left thoracic dermatomes 4–5. Intravenous acyclovir was administered and all patients recovered fully without any significant sequelae. VZV reactivation can lead to various neurological complications in immunocompetent children. Early recognition and treatment with acyclovir are important for improving the outcome of neurologic complications of VZV reactivation.
Acyclovir ; Central Nervous System Infections ; Chickenpox ; Child* ; Early Diagnosis ; Exanthema ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Meningitis, Aseptic* ; Skin ; Spinal Nerves

PURPOSE: To evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus. METHODS: We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia. RESULTS: The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson's sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia. CONCLUSION: Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases.
Conjunctivitis ; Glaucoma ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Incidence ; Intraocular Pressure ; Keratitis ; Medical Records ; Neuralgia, Postherpetic ; Paralysis ; Prevalence ; Recurrence ; Retrospective Studies ; Risk Factors* ; Scleritis ; Skin ; Time-to-Treatment ; Trigeminal Nerve

PURPOSE: To report two case of oculomotor palsy accompanied by herpes zoster ophthalmicus (HZO). CASE SUMMARY: Two patients with HZO who were suffering from skin lesions, facial pain, and medicated with an antiviral agent from the dermatologic department, were diagnosed with oculomotor palsy. They presented with ptosis, dilated pupils, and ophthalmoplegia after 10 days, and 4 days after began developing skin lesions. They were diagnosed with HZO-induced oculomotor palsy and the ophthalmoplegia improved in all cases. CONCLUSIONS: Oculomotor nerve palsy rarely occurrs in HZO patients and is usually followed by skin lesions. We recommend examinations for functions of extraocular motility, ptosis, and pupil to diagnose and treat the HZO-induced oculomotor nerve palsy even if consulted with the dermatologic department or only showing mild conjunctivitis, episcleritis, or keratitis.
Conjunctivitis ; Facial Pain ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Keratitis ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Pupil ; Scleritis ; Skin

BACKGROUND: Studies on herpes zoster have been extensively reported in Korea. However, few reports have dealt with herpes zoster in children and adolescents. OBJECTIVE: The purpose of this study was to investigate the epidemiological features and clinical characteristics of herpes zoster in children and adolescents. METHODS: During a 10-year period (2005~2014), 95 herpes zoster patients, aged 18 years and younger, were evaluated in regard to the annual, monthly, and seasonal incidences; the age distribution; and the gender ratio. The children and adolescents with herpes zoster were further assessed on the accompanying symptoms, dermatomal distribution, associated diseases, treatments, and complications. RESULTS: Among all the patients with herpes zoster, 2.41% were children and adolescents. The highest incidence was in summer (35.8%). The age group of 10 to 14 years had the highest incidence (40.0%). The male to female ratio was 1.4:1. The common accompanying symptoms were pain (77.9%) and pruritus (22.1%). The most common dermatomal distribution was the thoracic dermatome (50.5%), followed by the cervical (21.1%), the trigeminal (16.8%), the lumbar (7.4%) and the sacral (4.2%) dermatomes. Associated diseases including atopic dermatitis, bronchial asthma, allergic rhinitis, chronic sinusitis, and epilepsy were observed in 23.2%. There was no case with immunosuppression. The most common complication was secondary bacterial infection (5.2%), followed by herpes zoster ophthalmicus or herpes zoster generalisatus (4.2%), Ramsay Hunt syndrome (2.1%), meningitis and recurrent herpes zoster (1.1%). No patient developed postherpetic neuralgia. CONCLUSION: Herpes zoster is rare and relatively mild in healthy immunocompetent children and adolescents. Pruritus was observed in some pediatric patients, but there was no occurrence of postherpetic neuralgia.
Adolescent* ; Age Distribution ; Asthma ; Bacterial Infections ; Child* ; Dermatitis, Atopic ; Epilepsy ; Female ; Herpes Zoster Ophthalmicus ; Herpes Zoster Oticus ; Herpes Zoster* ; Humans ; Immunosuppression ; Incidence ; Korea ; Male ; Meningitis ; Neuralgia, Postherpetic ; Pruritus ; Retrospective Studies* ; Rhinitis, Allergic ; Seasons ; Sinusitis

PURPOSE: To report a case of multiple serous chorioretinopathy after facial herpes zoster. CASE SUMMARY: A 48-year-old male visited our clinic due to visual disturbance in the left eye which occurred 3 days after left facial pain and vesicles. Chemosis and multiple serous retinal detachments were found. The patient was diagnosed with multiple serous chorioretinopathy due to herpes zoster virus and was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 9 days and herpes eye ointment 5 times daily. After the initial treatment, oral prednisolone 60 mg was given daily for 6 days. Skin lesions were cleared, and abnormal fundus and visual acuity improved after treatment. CONCLUSIONS: Ophthalmopathy including multiple serous chorioretinopathy should be considered in managing herpes zoster ophthalmicus patients.
Acyclovir ; Facial Pain ; Herpes Zoster Ophthalmicus ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Male ; Middle Aged ; Prednisolone ; Retinal Detachment ; Skin ; Visual Acuity

PURPOSE: To report a case of complete oculomotor nerve palsy with pupil involvement complicated by inflammation of the cavernous sinus. Complete resolution was obtained after 12 days of antiviral and steroid treatments. CASE SUMMARY: A 60-year-old male presented with edema and vesicles of the right upper eyelid. The patient had myalgia, cough, fever and headache 1 week earlier and was treated with conservative therapy. The patient received an antiviral agent (famciclovir 250 mg) twice a day and steroid agent (methylprednisolon 4 mg) once a day at the dermatology department for 1 week. The eyelid edema and vesicles improved. However, ptosis, ocular movement limitation, mydriasis of the right eye and diplopia occurred. Brain magnetic resonance imaging revealed hyperintensity in the right cavernous sinus with enhancement, implicating inflammation. The patient was diagnosed with right complete oculomotor nerve palsy with pupil involvement. An antiviral agent (famciclovir 250 mg) three times a day and a steroid agent (prednisolone 40 mg) once a day were prescribed. From the next day, ptosis and ocular movement limitation improved and 12 days later, completely resolved. CONCLUSIONS: Ocular movement limitation and mydriasis can be accompanied by herpes zoster ophthalmicus without uveitis and cerebral aneurysm. Administering active antiviral and steroid treatment to obtain rapid resolution is important.
Brain ; Cavernous Sinus* ; Cough ; Dermatology ; Diplopia ; Edema ; Eyelids ; Fever ; Headache ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans ; Inflammation* ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myalgia ; Mydriasis ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Pupil ; Uveitis

PURPOSE: We report a case of stromal keratitis, corneal infiltration, anterior uveitis, central retinal artery occlusion and optic neuropathy in a patient with herpes zoster ophthalmicus. CASE SUMMARY: A 73-year-old man who was hospitalized for pain and vesicles on his left face was referred to our clinic with sudden onset visual disturbance in his left eye. His best corrected visual acuity in the right eye was 0.8 and light-perception in his left eye. Relative afferent pupillary defect was found in his left eye. Slit-lamp examination showed anterior uveitis secondary to herpes zoster ophthalmicus presented with stromal keratitis. Fundus examination showed retinal hemorrhage, vitreous opacity, cherry-red spot in the fovea and optic disc swelling. Delayed arterial filling and arteriovenous transit time were observed on fluorescence angiography. He was treated with topical antiviral and steroid eye drops for stromal keratitis and anterior uveitis. He was also treated systemically with an intravenous antiviral agent and oral steroid, but visual acuity did not improve. CONCLUSIONS: Stromal keratitis, corneal opacity, anterior uveitis, central retinal artery occlusion and optic neuropathy can be complications of herpes zoster ophthalmicus.
Aged ; Corneal Opacity ; Fluorescein Angiography ; Herpes Zoster Ophthalmicus* ; Humans ; Keratitis ; Ophthalmic Solutions ; Optic Nerve Diseases ; Pupil Disorders ; Retinal Artery Occlusion ; Retinal Hemorrhage ; Uveitis, Anterior ; Visual Acuity