Skin-nontumor / Clinical dermatology
Infectious disorders
Herpes simplex or varicella zoster

Author: Mowafak Hamodat, M.D. (see Authors page)

Revised: 25 May 2016, last major update September 2010

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Herpes simplex [title] AND varicella zoster [title]

Definition / General
  • Painful diseases caused by herpes simplex virus (HSV) or varicella zoster virus (VZV, also causes chickenpox)
Clinical Features
  • For both viruses, after primary infection, viral particles reside in sensory ganglia and are dormant until they erupt as recurrent herpes simplex virus or shingles (zoster)
  • The two viruses are differentiated by culture (difficult to culture zoster) or immunologic methods

  • Herpes simplex:
    • Historically, HSV1 was associated with herpes labialis (90%), and HSV2 was associated with herpes genitalis (90%), although in some recent studies, most genital lesions are caused by HSV1
    • Visceral involvement is most often seen in the lung, liver and brain
    • Today, diagnosis is often confirmed by PCR or immunohistochemistry
    • The multinucleated cells are the diagnostic features of the historic Tzank test, a Giemsa stained smear of vesicle contents
    • In the past, the laboratory diagnosis of herpes infection was confirmed by growth in tissue culture, electron microscopy, immunofluorescence of viral specific protein or viral DNA hybridization

  • Varicella zoster:
    • Varicella zoster is associated with leukemia and lymphoma, SLE and post-radiation or post-chemotherapy status
    • Occurs in 40 - 50% of patients in the first year following bone marrow transplantation
    • Shingles has dermatomal distribution or severe involvement of trigeminal nerve-first division (ophthalmic division) with corneal ulceration and herpetic keratitis

  • Description:
    • Grouped vesicles on an erythematous base, later become pustules, then crusts
Treatment
  • Acyclovir; also valacyclovir, penciclovir and famciclovir (eMedicine)
Clinical Images

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Breast skin, courtsey of Dr. Mark R. Wick



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Dermatomal distribution of zoster



Verrucous varicella-zoster on leg

Micro Description
  • Keratinocytes are multinucleated, acantholytic with distinct nuclear inclusions, found initially in follicular epithelium
  • Late epidermal necrosis or full-thickness acantholysis
  • Dermal nerve twigs may exhibit a perineural infiltrate of lymphocytes and neutrophils, sometimes associated with intraneural involvement
  • Schwann cell hypertrophy and frank neural necrosis are occasionally encountered
Micro Images

Images hosted on PathOut servers:

Breast skin, courtesy of Dr. Mark R. Wick



Images hosted on other servers:

Multinucleated cells, some with intranuclear inclusions

Cytology Images

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Tzanck smear, courtesy of Dr. Mark R. Wick