Herpes zoster: a photo gallery

Herpes zoster is a viral disease. Its development is directly related to the reactivation of the human herpesvirus type 3. At certain points in life, 10%–20% of the population is at risk of developing this condition. The likelihood of disease increases significantly in immunocompromised individuals, including those with HIV infection, malignancies, or those who have undergone bone marrow transplantation, or are receiving long-term cytostatic or systemic glucocorticoid therapy. In people living with HIV, herpes zoster occurs 8–15 times more frequently than in the general population. In immunodeficient states, including HIV-associated immunodeficiency, the course of herpes may have distinct features. This photo gallery presents cases of herpes zoster that developed in the setting of HIV infection. In such cases, clinical manifestation typically occurs when CD4+ T-cell counts fall below 400 cells/μL. In patients not receiving antiretroviral therapy, deeper immunosuppression may lead to recurrence. In some patients with low immune status, herpes zoster may appear as a manifestation of immune system reconstitution inflammatory syndrome. The severity and clinical presentation of the disease are largely determined by the degree of immunodeficiency. In HIV-infected individuals, multidermatomal involvement—affecting two or more dermatomes simultaneously—is common. Compared to HIV-negative individuals, the vesicular eruption phase may last more than 10 days, and atypical forms are more frequently observed (e.g., hemorrhagic, ulceronecrotic, verrucous, disseminated, generalized), which may occur in combination and present with more intense and deeper skin lesions. In HIV-infected individuals, localization of lesions in the external auditory canal is associated with a high risk of auditory involvement, whereas localization in the area innervated by the ophthalmic branch of the trigeminal nerve implies a risk of visual impairment. One possible complication is Ramsay Hunt syndrome (characterized by vesicles in the auricular region, ear pain, and facial nerve paresis or paralysis). According to the Russian clinical classification, the first episode of herpes zoster in a person living with HIV may serve as the basis for diagnosing stage 2B (acute HIV infection with secondary diseases) or stage 4A (secondary diseases) depending on the duration of HIV infection. Recurrent or disseminated herpes zoster corresponds to stage 4B. This photo gallery presents various clinical forms and anatomical locations of herpes zoster in patients with HIV infection. The descriptions of the lesions specify their location in accordance with the innervation zones of peripheral sensory nerves. All photographs presented in this article are from the author’s personal archive.