Hair Loss after Varicella Zoster Virus

Varicella zoster virus (VZV) cutaneous infection occurs predominantly in epidermal and
infundibular keratinocytes and accessorily in dermal dendritic cells. These latter cells play a
role in cicatricial processes. Two patients are presented with localized alopecia after VZV
infection. A 4-year-old girl presented localized hair loss affecting about 20% of her upper
right eyelash immediately following the resolution of the varicella skin lesions. No regrowth
was observed after 3 months. An 80-year-old woman with a prior history of localized
alopecia areata of the left occipital area presented severe left herpes zoster affecting the V1
and V2 dermatomes. At precisely the same site of the previous episode, a localized plaque of
alopecia areata recurred. After topical corticosteroid therapy, a progressive hair regrowth
occurred after about 3 months. These case reports are the first relating cutaneous VZV
infection as the origin for permanent cicatricial alopecia and transitory alopecia areata.
Localized hair loss should be added to the cutaneous complications of VZV skin infection.