Characteristics of Japanese Patients With Disseminated Herpes Zoster: A Retrospective Study of 20 Cases

Background Method

Japanese population, our results showed 25%. This suggested that hypertension and hyperlipidemia were also the risk factors for disseminated herpes zoster in Japanese patients.

Conclusion
Hypertension and hyperlipidemia were the proposed risk factors for disseminated herpes zoster in Japanese patients, in addition to age and immunode ciency.

Background
Disseminated herpes zoster is a common dermatological disease. Herpes zoster is caused by the varicella-zoster virus (VZV) [1]. Occasionally, VZV causes disseminated herpes zoster and requires hospitalization [2,3]. Age and immunode ciency have been identi ed as the risk factors for herpes zoster [4]. In particular, age is reportedly a signi cant risk factor. The risk of herpes zoster infection begins to increase after the age of 50 years, and 50% of people develop herpes zoster by the age of 85 years [5][6][7][8].
However, the risk factors for recurrent cellulitis are reportedly different from those in other countries due to the different characteristics of Japanese patients [9].
In this study, we hypothesized that the background of disseminated herpes zoster was different from that of other countries. We investigated other characteristics of disseminated herpes zoster that were unique to Japanese patients.

Methods
We retrospectively examined cases of disseminated herpes zoster hospitalization between April 1, 2005, and March 31, 2018. Herpes zoster was clinically diagnosed by dermatologists. We received written informed consent for this study from all inpatients on admission. All patients were treated with acyclovir. We have con rmed in follow-up that the disseminated herpes zoster had improved. No statistical analysis was performed in this study.

Results
Twenty patients were hospitalized for generalized herpes zoster during the target period. Table 1 shows the patient background. The mean patient age was 68.35 ± 15.76 years. Recurrence was observed in only one patient. Hypertension was observed in 35%, hyperlipidemia in 25%, cancer in 30%, and autoimmune disease in 20% of patients. Table 2 shows the results of the blood tests. The blood test results were unremarkable.

Discussion
We examined the results of 20 cases of disseminated herpes zoster infection. The recurrent case of disseminated herpes zoster involved a patient with dermatomyositis taking prednisolone (17.5 mg).
Therefore, he was considered to be in an immunosuppressive state. Based on previous reports, disseminated herpes zoster may recur in immunocompromised patients [5][6][7][8].
The results in Table 1 suggest that herpes zoster was more likely to occur in older immunosuppressed patients. This nding was similar to that of previous reports [4]. In contrast to a previous report stating that hypertension occurred in approximately 6% of Japanese patients [10], our results showed that 35% of patients in this study had hypertension. Similarly, in contrast to the previously reported rate of hyperlipidemia of 2% in Japanese patients, our results indicated 25% [11]. This suggested that hypertension and hyperlipidemia were also risk factors for disseminated herpes zoster in Japanese patients.
This study was limited because it was a single-center, retrospective study. Additionally, JR Tokyo General Hospital plays a central role in the region, and patients who visited this hospital were examined at this hospital. However, in Japan, patients are free to choose which hospital to visit. Therefore, they may not have reported previous hospitalizations.