Varicella-zoster virus infection: a review about varicella and herpes zoster

The Varicella-zoster virus (VZV) is a prevalent human pathogen that links dermatology, virology, and immunology. Following primary varicella infection, the virus establishes lifelong latency in the sensory ganglia, with reactivation manifesting as herpes zoster. The clinical spectrum ranges from typical dermatomal vesicular eruptions to atypical or disseminated presentations in older adults or immunocompromised patients, often posing diagnostic challenges. Early recognition and prompt initiation of antiviral therapy are essential to limit lesion progression, reduce viral shedding, and prevent complications. Dermatologists are uniquely positioned to identify these manifestations and distinguish VZV infection from its clinical mimics. Advances in molecular diagnostics have improved the detection of atypical cases, while the introduction of the attenuated-virus vaccine for varicella and recombinant glycoprotein E-based vaccine for herpes zoster has transformed prevention, providing durable protection even in older adults and immunosuppressed populations. Beyond therapy, dermatologists play a key role in integrating vaccination assessment and patient education into routine care. Understanding the biological continuum of VZV (from latency to reactivation) enhances diagnostic precision, guides evidence-based treatment, and supports immunization strategies against VZV. As VZV continues to impose a substantial burden of cutaneous and neuropathic morbidity, an integrated dermatological approach that combines early therapeutic intervention with preventive counseling represents the most effective strategy to reduce its clinical and public health impact.