Abstract
Purpose: To determine the true etiology of cases of putative recurrent shingles referred to a dermatology clinic. Methods: A prospective cohort study of patients aged 15-87 years with reported recurrent herpes zoster was conducted. Vesicular fluid and serology for herpes simplex 1, 2, and varicella zoster virus immunoglobulins were obtained from patients presenting with vesicles. Biopsies were obtained from patients with ambiguous presentations. Results: 44 patients (56%) had evidence of herpes simplex virus infection. 32% of patients had positive herpes simplex virus cultures or polymerase chain reaction sequencing, and 24% additional patients were diagnosed with presumptive simplex infection based on elevated antibody titers. 44% of patients had a diagnosis other than zoster or simplex. One individual had a positive viral culture for varicella zoster virus. 99% of patients who presented with suspected recurrent herpes zoster had no definitive evidence of varicella zoster virus reactivation. Conclusions: The most common diagnosis was herpes simplex infection. Our results suggest that true recurrent shingles in immunocompetent patients is rare.
Highlights
Herpes zoster, caused by reactivation of latent varicella–zoster virus, is characterized by a painful unilateral vesicular rash in a dermatomal distribution
Many immunocompetent persons report being diagnosed with recurrent herpes zoster, and recent studies have suggested that the incidence of herpes zoster recurrences is more frequent than previously reported, typically greater than 6%
The plausibility of recurrent herpes zoster has been debated, with many clinicians hypothesizing that recurrent zoster in immunocompetent patients is often a January 2021 Volume 5 Issue 1
Summary
Herpes zoster (shingles), caused by reactivation of latent varicella–zoster virus, is characterized by a painful unilateral vesicular rash in a dermatomal distribution. The incidence and severity of herpes zoster increase with age, in association with a decline in cell-mediated immunity.[1] The infection is usually limited to a single occurrence; recurrence is typically characteristic of immune compromise.[1] In immunocompetent persons, recurrent herpes zoster is thought to be rare, with an estimated incidence of 1-3%.1. Many immunocompetent persons report being diagnosed with recurrent herpes zoster, and recent studies have suggested that the incidence of herpes zoster recurrences is more frequent than previously reported, typically greater than 6%.2,3. It is reported that immunocompetent patients often experience more than two to three recurrent episodes, in the same dermatome.[2,3] the plausibility of recurrent herpes zoster has been debated, with many clinicians hypothesizing that recurrent zoster in immunocompetent patients is often a January 2021 Volume 5 Issue 1 Recurrent herpes zoster is thought to be rare, with an estimated incidence of 1-3%.1 many immunocompetent persons report being diagnosed with recurrent herpes zoster, and recent studies have suggested that the incidence of herpes zoster recurrences is more frequent than previously reported, typically greater than 6%.2,3 it is reported that immunocompetent patients often experience more than two to three recurrent episodes, in the same dermatome.[2,3] the plausibility of recurrent herpes zoster has been debated, with many clinicians hypothesizing that recurrent zoster in immunocompetent patients is often a January 2021 Volume 5 Issue 1
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