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Oral Herpes Zoster

Herpes zoster is due to reactivation of the varicella zoster virus, which causes chicken pox and remains dormant in the dorsal root ganglion. The incidence of the disease increases with age, with the majority of cases presenting after the age of 50. 2 Risk factors include increasing age, hospitalization, co-morbid conditions and cutaneous or mucosal trauma. One study found that those with craniofacial herpes zoster were twenty-five times as likely to have had facial trauma in the week prior compared to controls. 3 Diagnosis is often clinical, requiring no additional lab tests or imaging. A Tzanck smear may be performed to identify multinucleated giant cells. The differential diagnosis for oral lesions includes herpes zoster, primary syphilis, aphthous stomatitis and thermal burns. 4 Further diagnostic testing, such as direct fluorescent antibody testing, polymerase chain reaction (PCR) and viral culture may aid in the diagnosis but are frequently not used in the clinical setting.