Pediatric herpes zoster in North Africa: clinical features and complications

Sofia El Haitamy, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Zakia Douhi, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Meryem Soughi, Department of Dermatology, Hassan II University Hospital, Faculty of Medicine, Pharmacy and Dental Medicine, Sidi Mohamed ben Abdellah University of Fez, Fez, Morocco Sara Elloudi, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Hanane Baybay, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Fatima Zahrae-Mernissi, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco

Objective: To characterize the clinico-epidemiological profile, complications, and outcomes of pediatric herpes zoster (HZ) at a North African tertiary center. Method: Retrospective review of children < 18 years with clinical HZ (unilateral dermatomal vesicular rash) from February 2016 to April 2025. Results: Twenty patients (M: F 1.86:1; mean age 7.13 ± 3.77 years). Most (85%) were immunocompetent; three had chemotherapy-treated malignancies. Pruritus predominated (50%), followed by pain (20%). Thoracic dermatomes were most common (55%), then trigeminal (30%; ocular involvement in 4). Acute complications affected 60%: bacterial superinfection (30%), zoster keratitis (20%). No neurological sequelae or post-herpetic neuralgia occurred. 95% received oral antivirals. Lesions resolved within two weeks, except one immunocompetent child with permanent dyschromic macules and hypertrophic scarring. Conclusion: Pediatric HZ mainly affects immunocompetent children in our setting and carries substantial acute complication risk, especially trigeminal. Early recognition and prompt antivirals are essential to minimize morbidity. Consider HZ in any child with dermatomal vesicular rash, irrespective of immune status.

Keywords: Complications. Herpes zoster. Immunocompetent. North Africa. Pediatric. Trigeminal.