Jashin J. Wu (ed.)Clinical Cases in PsoriasisClinical Cases in Dermatology10.1007/978-3-319-52779-6_17

17. Herpes Zoster Reactivation in a 40-Year-Old with Psoriasis

Stacey Pun¹, Mina Amin², Daniel J. No³ and Jashin J. Wu⁴

(1)

Keck School of Medicine of USC, Los Angeles, CA, USA

(2)

University of California, Riverside School of Medicine, Riverside, CA, USA

(3)

Loma Linda University School of Medicine, Loma Linda, CA, USA

(4)

Wu Medical Associates, Inc., Los Angeles, CA, USA

Jashin J. Wu

Email: jashinwu@gmail.com

Keywords

Herpes zosterBiologic agentDMARDsVaccinationEtanerceptImmunosuppression

A 40-year-old male with an 8-year history of psoriasis and psoriatic arthritis presented to the clinic after discontinuing his medication following a herpes zoster outbreak 2 months ago. The shingles rash is completely resolved, and he denied residual pain, sensitivity to light touch, itching, or numbness. Before the infection, the patient’s psoriasis was moderately controlled with etanercept. The patient denied experiencing adverse side effects with etanercept. Since stopping the medication, he believed his psoriasis had worsened with new lesions appearing on his face, scalp, and extremities. He was interested in restarting a biologic agent as previous attempts with phototherapy and methotrexate were not beneficial. He was otherwise healthy and did not use other medications. He has a family history of psoriasis.

On physical examination, there were erythematous papules and plaques with micaceous scales diffusely on the face, scalp, and bilateral lower extremities. There was less involvement of the chest, abdomen, back, and bilateral upper extremities. Approximately 20% of the body surface area was affected.

Based on the case description, what is the best treatment recommendation for this patient?

1.

Avoid systemic agents in this patient; use topical therapy only.
2.

Topical therapy and restart etanercept 1 month after zoster vaccination.
3.

Immediately restart etanercept without vaccinating patient.
4.

Treat with etanercept and methotrexate.

Treatment

Topical therapy and restart etanercept 1 month after zoster vaccination.

Discussion

Herpes zoster (HZ) occurs when varicella-zoster virus, latent in the neurons of dorsal root ganglia, reactivates and spreads to involve the corresponding peripheral nerve. HZ classically presents with a prodrome of intense pain and dysesthesia in a dermatomal distribution. This prodromal syndrome is usually followed by the development of painful, grouped vesicles on erythematous bases in the same dermatome. However, pain occasionally occurs without the subsequent development of lesions and in this case is referred to as zoster sine herpete. The most common body area involved is the trunk, followed by the face, neck, scalp, and extremities. In other words, involvement of the thoracic, cervical, and ophthalmic dermatomes is most common. HZ may be mimicked by zosteriform herpes simplex virus, localized contact dermatitis, and bacterial infections like bullous impetigo (Bolognia et al. 2014).

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