DIFFERENTIAL DIAGNOSIS OF ACUTE HERPES ZOSTER

* H. Martina Lilie (1), Sawko W. Wassilew (1), Manfred H. Wolff (2)
(1) Dermatologic department, Klinikum Krefeld, Germany
(2) Institut of Microbiology and Virology, University of
Witten/Herdecke, Germany

Herpes zoster is a common disease caused by the varicella-zoster virus, an endogenic relapse of the primary infection of varicella.
Rapid diagnosis is necessary for the optimal efficacy of antiviral therapy. The diagnosis in the early stage of infection is difficult. Prodromal pain, tenderness or an erythema are the first signs of an acute herpes zoster. Differential diagnosis include erysipelas, herpes simplex infections, insect bites, acute contact dermatitis, etc.
In the present study skin biopsies of patients with herpes zoster and unclear skin changes were analysed by detecting viral DNA using the polymerase chain reaction (PCR) in order to amplify open reading frames (ORF) 14, 29 and 63.
VZV-DNA could be detected with PCR of all three ORF not only from blisters but also from erythematous skin of the affected segment in 17 patients with herpes zoster. In 9 out of 12 patients with segmented erythematous skin of unclear origin daily clinical controls of the skin symptoms made it possible to diagnose herpes zoster as well as by the detection of VZV-DNA with PCR. In the other 3 cases herpes zoster could not be diagnosed due to the absence of VZV-DNA. In these cases the diagnosis of e.g. herpes simplex infection, insect bite, etc. was also performed by the daily clinical controls of the skin eruptions.

Corresponding Author: Dr. H. Martina Lilie, Dermatologic Department, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany; Tel 0049 - 2151 - 32 - 2880;
Fax 0049 - 2151 - 32 - 2005; e-mail: lilie@klinikum-krefeld.de