Zosteriform dermatoses-A review

The zosteriform distribution of cutaneous lesions is a common disease pattern in dermatology. It describes a unilateral girdle-like distribution restricted to the sensitive nerve territory of a dermatome. Three different pathogenic pathways can lead to a zosteriform pattern. The neural pathway uses the axons of a nerve ganglion for viral transport to a specific dermatome. The arche type is Herpes Zoster (HZ) followed by Zosteriform Herpes Simplex Virus Type (HSV) I infection. The Blaschkoid pathway uses the Blaschko lines that represent embryonic migration patterns, often mimicking a dermatomal distribution, particularly on the trunk. The isotopic pathway defines a dermatosis that exclusively develops on the site of a previously healed HZ eruption. Before a zosteriform eruption, a history of prior HZ guides the diagnosis to the isotopic pathway, mainly represented by granulomatous reactions followed by, among others, lichen planus, vasculitis and basal cell carcinoma. With no prior history of HZ recent eruptions orientate towards HZ and zosteriform HSV, whereas chronic eruptions should primarily evoke cutaneous metastases, principally from breast, ovary and lung carcinoma. This review summarizes the relevant literature and presents a clinical algorithm for the differential diagnosis of zosteriform dermatoses.