Herpes zoster on the forehead masquerading as an abscess complication to look out for: a case report





Adult, Complication, Female, Herpes zoster, Varicella-zoster virus


Herpes zoster or shingles is caused by the reactivation of latent varicella zoster virus (VZV) infection within the sensory ganglia. Primary VZV infection results in varicella (chickenpox) usually in childhood, characterized by vesicular lesions on the face, trunk, and extremities. Although herpes zoster can occur at any age, it is mainly a disease of adults over age 50 and/or immunocompromised individuals. Complications of herpes zoster include post herpetic neuralgia, herpes zoster ophthalmic us and less commonly acute retinal necrosis, aseptic meningitis, and encephalitis. Here we present the case of a 51-year-old female patient with Herpes Zoster infection involving the dermatome on the forehead, initially misdiagnosed, to alert clinicians to create awareness and minimize misdiagnosis of other patients with similar cases. It is unusual to find patients presenting with infection involving the dermatome of the forehead.



Hamborsky J. Epidemiology and Prevention of Vaccine-Preventable Diseases. Washington D.C. Public Health Foundation 2015;13:353-74.

Cohen Jl. Merck and Merck Manuals. Shingles (Herpes Zoster) Signs and Symptoms Clinical practice: Herpes zoster. The New England J Medicine. 2013;369(3):255-63.

Johnson W, Alvarez-Pasquin J, Bijl M, Franco E, Gaillat J, Clara JG, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Ther Adv Vaccines. 2015;3(4):109-20. Erratum in: Ther Adv Vaccines. 2016;4(1-2):32. PubMed PMID: 26478818; PubMed Central PMCID: PMC4591524.

Friedman-Kien E, Lafleur L, Gendler E, Hennessey P, Montagna R, Halbert S, et al. Herpes zoster: a possible early clinical sign for development of acquired immunodeficiency syndrome in high-risk individuals. J Am Acad Dermatol. 1986;14(6):1023.

UpToDate. Varicella virus vaccine (VAR): Pediatric drug information. Available at; https://www.uptodate.com/contents/varicella-virus-vaccine-var-pediatric-drug-information?topicRef=10038&source=see_link. Accessed 10 July 2019.

Yawn BP, Saddier P, Wollan PC, Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007(11);82:1341-9.

Christopher H, John J, Erik S, Abena O. Approach to the patient with cutaneous blisters. Available at; https://www.uptodate.com/contents/approach-to-the-patient-with-cutaneous-blisters. Accessed 10 July 2019.

Liesegang TJ. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmol. 2008;115(2):S3-12.

Ragozzino MW, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine. 1982 Sep;61(5):310-6.

Tomkinson A, Roblin DG, Brown MJ. Hutchinson's sign and its importance in rhinology. Rhinol. 1995 Sep;33(3):180-2.

Zaal J, Völker-Dieben J, D'Amaro J. Prognostic value of Hutchinson's sign in acute herpes zoster ophthalmicus. Graefes Arch Clin Exp Ophthalmol. 2003 Mar 1;241(3):187-91.

Millar P, Troulis J. Herpes zoster of the trigeminal nerve: the dentists’ role in diagnosis and treatment. J Can Dent Assoc. 1994;60(5):450-3.

Schmader E, Dworkin H. Natural history and treatment of herpes zoster. J Pain. 2008;9(1):S3-9.

Thomas L, Hall J. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis 2004;4(1):26-33.

Miller G, Dummer S. Herpes simplex and varicella zoster viruses: forgotten but not gone. Am J Transplant. 2007;7(4):741-7.

Donahue G, Choo W, Manson E, Platt R. The incidence of herpes zoster. Arch Intern Med. 1995; 155(15):1605-9.

Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin. Infect. Dis. 2007;44(1):S1-26.

Carmichael K. Treatment of herpes zoster and postherpetic neuralgia. Am Fam Physician 1991; 44(1):203-10.

Tidwell E, Hutson B, Burkhart N, Gutmann JL, Ellis CD. Herpes zoster of the trigeminal nerve third branch: a case report and review of the literature. Int Endod J 1999;32(1):61-6.

Tyring S, Barbarash A, Nahlik E, Cunningham A, Marley J, Heng M, et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study group. Ann Intern Med. 1995;123(2):89-96

Ramchandani L, Mellor K. Herpes zoster associated with tooth resorption and periapical lesions. Br J Oral Maxillofac Surg. 2007;45(1):71-3.

Gnann W, Whitley J. Clinical practice. Herpes zoster. N Engl J Med. 2002;347(5):340.

Pollak L, Dovrat S, Book M, Mendelson E, Weinberger M. Varicella zoster vs. herpes simplex meningoencephalitis in the PCR era. A single center study. J the Neurological Sciences. 2011;314(1-2):29-36.




How to Cite

Ummer, F. P., Dhaiban, T. M., & Veettil, S. T. (2019). Herpes zoster on the forehead masquerading as an abscess complication to look out for: a case report. International Journal of Research in Medical Sciences, 7(9), 3546–3549. https://doi.org/10.18203/2320-6012.ijrms20193667



Case Reports