Chickenpox is a highly contagious infection caused by the herpes virus Varicella zoster. It is typically seen in children where it causes crops of pruritic cutaneous vesicles. It is usually transmitted by direct contact and has an incubation period of 2-3 weeks. The exanthem is frequently preceded by a slight fever, malaise and mild headache. The cutaneous lesions start as an itchy macular rash, which progressively becomes vesicular and pustular before breaking down to form focal crusting lesions. They tend to erupt in crops, but lesions at all stages of evolution are frequently present. The back and chest are often the first sites of involvement, but later lesions appear on the face, neck and limbs. They can involve the nose, ears, conjunctiva and genital areas. In the mouth they form small, non-specific, scattered ulcers. The symptoms last from a few days to 2 weeks. In many cases the virus remains latent in dorsal root ganglia.
Herpes zoster (shingles) is due to reactivation of the Varicella zoster virus. In the orofacial region it is characterised by pain, a vesicular rash and stomatitis in the related dermatome. Unlike herpes labia-lis, repeated recurrences of zoster are very rare. Occasionally there is an underlying immunodeficiency. Herpes zoster is a hazard in organ transplant patients and can be an early complication of haematolymphoid neoplasms and HIV infections. Herpes zoster usually affects adults of middle age or older, but occasionally involves children. The first signs are often pain, irritation or tenderness in one or more divisions of the trigeminal nerve. The pain may be severe and can be misinterpreted as toothache, leading to inappropriate dental intervention. Malaise and low-grade fever are common constitutional symptoms. There is usually a strikingly unilateral, vesicular exanthem restricted to the affected dermatome. Intraorally, there may also be extensive unilateral ulceration in the distribution of the involved nerves. There is usually tender regional lymphadenopathy. The acute phase lasts about 7-10 days, but pain may continue until the lesions ul cerate and crust over, which may take several weeks, especially if there is suppuration and subsequent scarring. In these circumstances a significant number of patients develop the most unpleasant consequence of post-herpetic neuralgia.
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