Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Hair follicle involvement in herpes zoster: pathway of viral spread from ganglia to skin

  • 76 Accesses

  • 7 Citations


Herpes zoster is caused by reactivation of varicella-zoster virus (VZV) persisting in dorsal root or trigeminal ganglia. To clarify the pathway of viral spread from the ganglia to skin, 16 biopsy specimens of early skin lesions of herpes zoster obtained from the face and trunk of 13 patients were studied histologically and immunohistochemically using monoclonal antibodies to the structural proteins of VZV. VZV-infected cells were detected in the hair follicles in 10 of the 16 specimens and in the epidermis in 2 specimens. Infected cells were localized in the isthmus of every involved follicle (12/12), frequently in the stem (8/10) and infundibulum (6/10), and never in the bulb. The high frequency of follicular involvement in herpes zoster suggests that VZV spreads to the area of skin innervated by myelinated nerves, which end around the isthmus of hair follicles and sebaceous glands.

This is a preview of subscription content, log in to check access.


  1. 1.

    Bastian FO, Rabson AS, Yee CL, Tralka TS (1974) Herpesvirus varicellae: isolated from human dorsal root ganglia. Arch Pathol 97:331–333

  2. 2.

    Cheatham WJ (1953) The relation of heretofore unreported lesions to pathogenesis of herpes zoster. Am J Pathol 29:401–411

  3. 3.

    Croen KD, Ostrove JM, Dragovic LJ, Straus SE (1988) Patterns of gene expression and sites of latency in human nerve ganglia are different for varicella-zoster and herpes simplex viruses. Proc Natl Acad Sci USA 85:9773–9777

  4. 4.

    Esiri MM, Tomlinson AH (1972) Herpes zoster Demonstration of virus in trigeminal nerve and ganglion by immunofluorescence and electron microscopy. J Neurol Sci 15:35–48

  5. 5.

    Gelb LD (1990) Varicella-zoster virus. In: Field BN, Knipe DM, et al (eds) Virology, 2nd edn. Raven Press, New York, pp 2011–2054

  6. 6.

    Ghatak NR, Zimmerman HM (1973) Spinal ganglion in herpes zoster: a light and electron microscopic study. Arch Pathol 95:411–415

  7. 7.

    Gilden DH, Vafai A, Shtram Y, Becker Y, Devlin M, Wellish M (1983) Varicella-zoster virus DNA in human sensory ganglia. Nature 306:478–480

  8. 8.

    Hasegawa T (1971) Further electron microscopic observations of herpes zoster virus. Arch Dermatol 103:45–49

  9. 9.

    Head H, Campbell AW (1990) The pathology of herpes zoster and its bearing on sensory localization. Brain 23:353–523

  10. 10.

    Hope-Simpson RE (1965) The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Soc Med 58:9–20

  11. 11.

    Hyman RW, Ecker JR, Tenser RB (1983) Varicella-zoster virus RNA in human trigeminal ganglia. Lancet II:814–816

  12. 12.

    Kawamura T (1954) Über die menschliche Haarscheibe unter besonderer Berücksichtigung ihrer Innervation und subepidermalen perineuralen Pigmenthülle. Hautarzt 5:106–109

  13. 13.

    Montagna W, Parakkal PF (1974) The structure and function of skin, 3rd edn. Academic Press, New York

  14. 14.

    Muraki R, Baba T, Iwasaki T, Sata T, Kurata T (1992) Immunohistochemical study of skin lesions in herpes zoster. Virchows Arch [A] 420:71–76

  15. 15.

    Nagashima K, Nakazawa M, Endo H, Kurata T, Aoyama Y (1975) Pathology of the human spinal ganglia in varicella-zoster virus infection. Acta Neuropathol 33:105–117

  16. 16.

    Nikkels AF, Debrus S, Sadzot-Delvaux C, Piette J, Delvenne P, Rentier B, Pierard GE (1993) Comparative immunohistochemical study of herpes simplex and varicella-zoster infections. Virchows Arch [A] 422:121–126

  17. 17.

    Nikkels AF, Delvenne P, Debrus S, Sadzot-Delvaux C, Piette J, Rentier B, Pierard GE (1995) Distribution of varicella-zoster virus gpI and gpII and corresponding genome sequences in the skin. J Med Virol 46:91–96

  18. 18.

    Okuno T, Yamanishi K, Shiraki K, Takahashi M (1983) Synthesis and processing of glycoproteins of varicella-zoster virus (VZV) as studied with monoclonal antibodies to VZV antigens. Virology 129:357–368

  19. 19.

    Orfanos CE, Runne U (1975) Virusausbreitung, Virusreplication, and Viruselimination in der menschlichen Haut beim Zoster. Hautarzt 26:181–190

  20. 20.

    Shibuta H, Ishikawa T, Aoyama Y, Kurata K, Matumoto M (1974) Varicella virus isolation from spinal ganglion. Arch Ges Virusforsch 45:382–385

  21. 21.

    Weller TH, Witton HM, Bell EJ (1958) The etiologic agents of varicella and herpes zoster: isolation, propagation, and cultural characteristics in vitro. J Exp Med 108:843–868

  22. 22.

    Winkelmann RK (1959) The innervation of a hair follicle. Ann NY Acad Sci 83:400–407

Download references

Author information

Correspondence to T. Iwasaki.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Muraki, R., Iwasaki, T., Sata, T. et al. Hair follicle involvement in herpes zoster: pathway of viral spread from ganglia to skin. Vichows Archiv A Pathol Anat 428, 275–280 (1996). https://doi.org/10.1007/BF00196701

Download citation

Key words

  • Varicella-zoster virus
  • Herpes zoster
  • Immunohistochemistry
  • Hair follicle
  • Sebaceous gland