title: Satellite lesions accompanying herpes zoster: a new prognostic sign for high-risk zoster.
abstract: BACKGROUND
  The incidence, clinical relevance and pathogenesis of single, isolated, varicella-like skin lesions occurring far beyond the primary herpes zoster (HZ)-affected dermatome remain unclear.
  
  
  OBJECTIVE
  To search prospectively for these satellite lesions in 120 patients with HZ and to correlate their presence with a series of clinical, histological and virological data.
  
  
  METHODS
  Relevant clinical data were recorded from 109 patients with proven HZ using immunohistochemistry on Tzanck smears. Furthermore, skin biopsies and blood samples were obtained from a subgroup of patients presenting with primary HZ with and without satellite lesions for histology, immunohistology, serology and real-time polymerase chain reaction.
  
  
  RESULTS
  This study identified satellite lesions in 21·1% of the patients with HZ. Their presence conveyed a statistically significant relative risk (RR) for severe (RR 3·27, P < 0·001), multidermatomal (RR 10·6, P < 0·001) and multistage HZ (RR 3·30, P < 0·001); systemic signs (RR 2·08, P = 0·0031); immunosuppression (RR 2·38, P = 0·0014) and hospitalization (RR 2·94, P < 0·001). Varicella zoster virus (VZV) viraemia was higher (mean 4075 copies mL(-1) ) in patients with HZ with satellite lesions than in those without (mean 1466 copies mL(-1) ). In contrast to HZ lesions, satellite lesions often presented positive VZV immunostaining in endothelial cells, suggesting a similar pathogenesis to varicella. A limitation of this study is the centre-linked overrepresentation of immunocompromised patients.
  
  
  CONCLUSIONS
  Total-body examination searching for satellite lesions is a rapid, simple and reliable tool for identifying patients with high-risk HZ.
authors.affiliation: Department of Dermatology, University of Liège, B-4000, Liège, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: El Hayderi
authors.affiliation: Department of Fundamental Virology, University of Liège, B-4000, Liège, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Bontems
authors.affiliation: Department of Dermatology, University of Liège, B-4000, Liège, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Nikkels-Tassoudji
authors.affiliation: Department of Dermatopathology, University of Liège, B-4000, Liège, Belgium.
authors.forename: J E
authors.initials: JE
authors.lastname: Arrese
authors.affiliation: Department of Biostatistics, University of Liège, B-4000, Liège, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Seidel
authors.affiliation: Department of Fundamental Virology, University of Liège, B-4000, Liège, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Meex
authors.affiliation: Department of Dermatology, University of Liège, B-4000, Liège, Belgium.
authors.forename: A F
authors.initials: AF
authors.lastname: Nikkels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006562:Herpes Zoster / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007121:Immunocompetence / Q000502:physiology; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D055815:Young Adult