Clinical Profile, Dermatomal Patterns, and Complications of Herpes Zoster in Immunocompetent Patients: A Hospital-Based Observational Study

Background: Herpes zoster (HZ) results from reactivation of varicella zoster virus (VZV) that persists in latent form within sensory ganglia following primary varicella infection. Although classically associated with advancing age and immunosuppression, the disease poses a significant clinical burden even in immunocompetent hosts. Data characterizing the disease course in this population from South Indian tertiary care settings remain limited.

Objectives: To describe the clinical profile, dermatomal distribution, morphological patterns, complications, and disease course of herpes zoster among HIV-seronegative patients attending a tertiary dermatology unit.

Methods: This observational study was conducted in the Department of Dermatology, Venereology and Leprosy, GGH/GMC Guntur from January 2019 to December 2020. One hundred and five HIV-seronegative patients with a clinical diagnosis of herpes zoster were enrolled. Clinical parameters including age, sex, dermatomes involved, morphology of lesions, pre-eruptive symptoms, duration of zoster-associated pain, time to cessation of new vesicle formation, healing of crusted lesions, and complications were systematically recorded.

Results: The study enrolled 105 HIV-negative patients. A slight female preponderance was noted (52.3% female). Herpes zoster was predominantly a disease of the older age group, with 67.6% of cases occurring above 40 years (mean age 45.3 years). Thoracic dermatome was the most commonly affected site (48.5%). The majority (75.2%) presented with vesicular morphology. Multidermatomal involvement was observed in 9.5% of cases, with one patient developing disseminated zoster on a background of chemotherapy for colorectal carcinoma. Complications included secondary bacterial infection (n=4), Ramsay Hunt syndrome (n=1), and ulcerative lesions (n=3). Mean time to cessation of new vesicle formation was 46.8 hours, and mean time to resolution of crusted lesions was 8.5 days. No seasonal variation in disease occurrence was observed.

Conclusions: Herpes zoster in immunocompetent patients follows a predictable course with age as a principal risk factor. Atypical presentations, while uncommon, can occur even in immunocompetent individuals. Thorough clinical assessment and follow-up remain essential to detect and manage complications early.