Revisiting childhood herpes zoster

Area of Science:

• Pediatrics
• Infectious Diseases
• Dermatology

Background:

• Herpes zoster (shingles) in children is uncommon but linked to immunosuppression.
• Maternal varicella and neonatal varicella are known risk factors for childhood shingles.
• Controversies exist regarding childhood herpes zoster risk factors, diagnosis, and natural history.

Purpose of the Study:

• To investigate the clinical presentation and risk factors of herpes zoster in children.
• To identify the causative viral agents in pediatric herpes zoster cases.
• To clarify the role of prior varicella infections in childhood shingles.

Main Methods:

• A 2-year prospective study of 18 children diagnosed with herpes zoster in a hospital dermatology unit.
• Clinical data collection including age, dermatome involvement, and varicella history.
• Laboratory analysis using Tzanck smears, biopsies, and serology for viral detection.

Main Results:

• Varicella zoster virus (VZV) glycoprotein gE detected in 16/18 smears and 4/4 biopsies; Herpes simplex virus 1 (HSV-1) in one smear.
• Established risk factors were present in only one child.
• Unrecognized or mild varicella infections were common, with 6/17 immunocompetent children having no recalled history but positive serology for past varicella.

Conclusions:

• Established risk factors for childhood herpes zoster are rare.
• Unrecognized or mild varicella infections may be significant risk factors for shingles in children.
• Accurate viral identification is crucial to differentiate herpes zoster from zosteriform herpes simplex virus infections.