Reactivation of the dormant herpes zoster virus (HZV), once believed to occur only in advanced adulthood, has been increasingly observed in children within just a few years of original exposure to the varicella zoster virus (VZV), according to study data published in Dermatologic Therapy. Results of this study indicated that, contrary to common belief, immunosuppression is not the most likely precipitating factor in children in whom HZV develops, and HZV may often occur in healthy children.

For the study, a total of 60 children (aged 6 months to 16 years) were identified as having HZV at 2 outpatient dermatology clinics in Turkey. The majority of patients (76.7%) had reported exposure to the varicella virus, according to their parents. Three of the children had received the VZV vaccine.

The investigators found that the disease course was milder in children compared with adults, who usually experience pain as the primary symptom. In the cohort of children, the most frequent symptom reported was itching in 48 patients (80%), followed by pain in 38 (63.3%). In 33 patients with both itching and pain, fever and weakness also occurred. Other symptoms included involvement of the thoracic region in 22 patients (36.7%), cervical involvement in 15 patients, lumbar involvement in 13 patients, sacral involvement in 7 patients, and trigeminal involvement in 3 patients (25%, 21.7%, 11.7%, and 5%, respectively). Ocular involvement was observed in 1 patient.

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Children aged 10 years and older were most likely to express symptoms in the thoracic and lumbar regions, while symptoms in the cervical, sacral, and trigeminal areas more often affected children under age 10.

Treatment with acyclovir was effective in 33 patients (55%). Another 15 (25%) were given valacyclovir and 9 (15%) received symptomatic therapy. The remaining 3 patients received no therapy. There were no complications reported with any therapy. The authors agreed with previous studies that indicated that early application of antiviral therapy within 72 hours of symptom onset and continuing for 7 days (or 2 days after the last appearance of a lesion) could be effective in hastening the healing process. They reported that while no special treatment is required for children, acyclovir would be the treatment of choice because of its long history of safety in pediatric populations.

The authors also noted a seasonality to HZV infection, which they attributed to reduced immune resistance during winter and spring months.

The study found that HZV can also develop in children who are otherwise considered healthy. Unlike adult patients, the most common symptom in the HZV is itching. “In healthy children without immunosuppression, early treatment may help rapid recovery from the disease and prevent complications,” the researchers suggested.

Reference

Aktaş H, Erdal SA, Güvenç U. Herpes zoster in children: evaluation of the sixty cases. Dermatol Ther. 2019:e13087.