Braz Dent J 13(1) 2002 Cutaneous herpes zoster 49 Braz Dent J (2002) 13(1): 49-52 Systemic and Oral Alterations in Brazilian Patients with Cutaneous Herpes Zoster Heron Fernando de Sousa GONZAGA 1 Maria Augusta JORGE 1 Lúcia Helena de Sousa GONZAGA 2 Calógeras A.A. BARBOSA 3 Marcelo Donizetti CHAVES 4 1 Research Center – Center of Higher Education of Dracena – CESD, Dracena, SP, Brazil 2 Department of Restorative Dentistry, Faculty of Dentistry, University of Marília, Marília, SP, Brazil 3 Department of Genetics and Evolution, Faculty of Health Sciences, Federal University of São Carlos, São Carlos, SP, Brazil 4 Department of Oral Pathology, Faculty of Dentistry, University of Campinas, Piracicaba, SP, Brazil Herpes zoster (HZ) is a virotic disease caused by Herpesvirus varicellae. The objective of this study was to determine the factors that trigger the disease, and the systemic and oral alterations present in Brazilian patients with herpes zoster. A total of 30 patients with HZ and 100 control patients with other diseases were studied. Of the 30 patients with HZ, 13 were male (43.3%) and 17 were female (56.7%), with an average age of 43.2 (range 3-78). The patients were submitted to general clinical, dermatological and intraoral examinations. Only 50% of the HZ patients reported emotional stress at the onset of the disease. A total of 3.7% of the patients were positive for HIV and 11.1% for systemic malignant neoplasm. Cutaneous lesions were found on the thorax (68.3%), face (20%), lower limbs (10%) and upper limbs (6.7%). Specific oral involvement such as oral HZ was not found. The presence of the disease may indicate a non-diagnosed malignant neoplasm and/or association with AIDS. Key Words: herpes zoster, varicella, mouth. Correspondence: Prof. Dr. Heron Fernando de Sousa Gonzaga, Research Center - Center of Higher Education of Dracena - CESD, Eng o . Byron de Azevedo Nogueira, Km 0, Vila Barros, Caixa Postal 1011, 17900-000 Dracena, SP, Brasil. e-mail: herongonzaga@terra.com.br ISSN 0103-6440 INTRODUCTION The association between varicella and herpes zoster (HZ) was first made in 1892. It was later recog- nized that the pathologic changes of herpes zoster were usually limited to one dorsal root ganglion or the sen- sory ganglion of a cranial nerve producing pain and skin lesions along the distribution of the involved nerve(s). It is now well established that a herpes zoster infection (shingles) requires pre-exposure to the vari- cella-zoster virus. The primary varicella virus infection causes an acute, generally mild, infection (chicken pox) and the virus subsequently establishes latency else- where within sensory ganglia. The virus is then later reactivated to cause a herpes zoster (HZ) infection (1). HZ in childhood is rather unusual (2), and both immunocompetent and immunocompromised individu- als may be affected (3). The most important etiologic factors of HZ are increased age or a compromised immune system. Emotional stress, especially recent events perceived as stressful, also seems to be an impor- tant factor (1). The presence of the disease may indicate a non-diagnosed malignant neoplasm. Many different malignant neoplasms may be probable factors that trig- ger HZ, such as Hodgkin’s disease, leukemias and lymphomas (4,5). More recently, AIDS has become an important factor because it may trigger HZ, causing a higher incidence of HZ among young people. An HZ virus outbreak is commonly character- ized by easily observed vesicular skin eruptions that follow the anatomic distribution of affected nerve(s) or nerve branch. Prodromal severe pain is almost always present during these outbreaks. In many cases, pain is the first symptom in the involved area(s) 3 to 5 days