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LETTER TO THE EDITOR
Year : 2013  |  Volume : 4  |  Issue : 4  |  Page : 369  

Zosteriform herpes simplex and herpes zoster: A clinical clue


Department of Dermatology, Venereology and Leprosy, Pondicherry Institute of Medical Sciences, Pondicherry, India

Date of Web Publication28-Oct-2013

Correspondence Address:
Satyaki Ganguly
Department of Dermatology, Venereology and Leprosy, Pondicherry Institute of Medical Sciences, Pondicherry - 605 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.120643

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How to cite this article:
Aithal S, Kuruvila S, Ganguly S. Zosteriform herpes simplex and herpes zoster: A clinical clue. Indian Dermatol Online J 2013;4:369

How to cite this URL:
Aithal S, Kuruvila S, Ganguly S. Zosteriform herpes simplex and herpes zoster: A clinical clue. Indian Dermatol Online J [serial online] 2013 [cited 2019 Dec 9];4:369. Available from: http://www.idoj.in/text.asp?2013/4/4/369/120643

Sir,

This is in response to the article, 'Recurrence of zosteriform lesions on the contralateral dermatome: A diagnostic dilemma.' by Udayashankar C et al. [1] They concluded that the patient had recurrence of zosteriform lesions on the left T4-5 dermatomes, of which T4 is the corresponding contralateral dermatome to the previous episode and had a diagnostic dilemma as they did not have the laboratory evidence for the causative organism, which could be either herpes simplex or varicella zoster virus.

We completely agree with the importance of identifying the causative organism as proper diagnosis will lead to more accurate therapy. [1] It is important to distinguish between these two viruses with the advent of antiviral drugs and isolation procedures. [2]

We would like to add a clinical clue, which could possibly help in differentiating between these two conditions. We would like to point out an important clinical observation by many authors that the vesicles of herpes simplex are uniform in size in contrast to the vesicles seen in herpes zoster, which vary in size. [3],[4],[5] In other words, vesicles of herpes simplex are uniform within a cluster. [3] A later recurrence proves the diagnosis of simplex. [4],[6] Koh MJ et al. reported a 65-year-old man who presented with recurrent episodes of a "zosteriform eruption". He was initially clinically diagnosed and treated for recurrent herpes zoster, but was subsequently found to have recurrent herpes simplex virus type 2 after laboratory investigations. [6]

With the above clinical clue it is more likely, from the clinical features and the photograph, that this was a case of zosteriform herpes simplex (uniform vesicles within a cluster).

 
   References Top

1.Udayashankar C, Oudeacoumar P, Nath AK. Recurrence of zosteriform lesions on the contralateral dermatome: A diagnostic dilemma. Indian Dermatol Online J 2012;3:76-7  Back to cited text no. 1
    
2.Kalman CM, Laskin OL. Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults. Am J Med 1986;81:775-8.  Back to cited text no. 2
    
3.Habif TP. Clinical Dermatology. 5 th ed. New Delhi: Elsevier; 2010. p. 454-90  Back to cited text no. 3
    
4.Lautenschlager S, Stockfleth E. Human herpes viruses. In: Burgdorf WHC, Plewig G, Wolff HH, Landthaler M, editors. Braun-Falco's Dermatology. 3 rd ed. Heidelberg: Springer Medizin Verilag; 2009. p. 74-92.  Back to cited text no. 4
    
5.Thappa DM. Essentials in Dermatology. 2 nd ed. New Delhi: Jaypee Brothers Medical Publishers Pvt. Ltd; 2009. p. 43-56.  Back to cited text no. 5
    
6.Koh MJ, Seah PP, Teo RY. Zosteriform herpes simplex. Singapore Med J 2008;49:e59-60.  Back to cited text no. 6
    




 

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