{"id":17735,"date":"2023-12-12T13:08:54","date_gmt":"2023-12-12T13:08:54","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=17735"},"modified":"2026-05-19T14:21:38","modified_gmt":"2026-05-19T13:21:38","slug":"recurrent-vesicular-rash","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/infectiousdiseases\/recurrent-vesicular-rash\/","title":{"rendered":"Recurrent Vesicular Rash"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong><em>Recurrent shingles is rare<\/em><\/strong> (especially \u2265 2 episodes) and requires <strong>laboratory confirmation<\/strong> as other aetiologies such as recurrent zosteriform herpes simplex should be considered. Wolf\u2019s post-herpetic isotopic response may also occur, resulting in the development of immunity related skin disorders at the site of a previous herpetic eruption.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Shingles is an <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/hiv-indicator-conditions\/\" target=\"_blank\" rel=\"noreferrer noopener\">HIV indicator condition<\/a>, and recurrences are more common in immunocompromised patients. All patients with shingles should be offered an HIV test and those with laboratory confirmed recurrent infection should have an evaluation for immune deficiency. Please see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/immunology\/recurrent-shingles-immune-deficiency\/\" target=\"_blank\" rel=\"noreferrer noopener\">Recurrent Shingles and Immune Deficiency<\/a> for further detail.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"536\" height=\"584\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-9.png\" alt=\"Recurrent Vesicular Rash\" class=\"wp-image-17736\" style=\"width:288px;height:auto\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-9.png 536w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/image-9-275x300.png 275w\" sizes=\"auto, (max-width: 536px) 100vw, 536px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">Public Health Image Library(PHIL) (cdc.gov)<\/span> image courtesy of <a href=\"https:\/\/phil.cdc.gov\/Details.aspx?pid=21507\" target=\"_blank\" rel=\"noreferrer noopener\">Details &#8211; Public Health Image Library(PHIL) (cdc.gov)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><strong><strong>C.M &amp; N.B 19-05-26<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">The RIDU team is happy to provide advice or outpatient review (referral via SCI Gateway) for patients with confirmed recurrent herpes virus infections who have not responded to first line treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">People living with HIV should be referred to Infectious Diseases or Chalmers.&nbsp;&nbsp;<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">Please send a vesicle swab in viral transport medium for HSV\/VZV PCR. Management should be driven by the results of the vesicle swab; appropriate treatment regimens can be found in the BNF.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with confirmed recurrent shingles (VZV) should be evaluated for underlying <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/immunology\/recurrent-shingles-immune-deficiency\/\" target=\"_blank\" rel=\"noreferrer noopener\">immune deficiency<\/a>. Antiviral prophylaxis is not indicated for individuals with recurrent shingles, but may be considered for those with recurrent herpes simplex virus (HSV) infections.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the aetiology of the rash is unclear and the PCR is negative, consider seeking Dermatology advice.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/hiv-indicator-conditions\/\" target=\"_blank\" rel=\"noreferrer noopener\">HIV indicator conditions<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/topics\/shingles\/\" target=\"_blank\" rel=\"noreferrer noopener\">Shingles | Health topics A to Z | CKS | NICE<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bhiva.org\/HIV-testing-guidelines\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bhiva.org\/HIV-testing-guidelines<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.gov.uk\/government\/publications\/shingles-herpes-zoster-the-green-book-chapter-28a\" target=\"_blank\" rel=\"noreferrer noopener\">Shingles (herpes zoster): the green book, chapter 28a &#8211; GOV.UK (www.gov.uk)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Recurrent shingles is rare (especially &ge; 2 episodes) and requires laboratory confirmation as other aetiologies such as recurrent zosteriform herpes simplex should be considered. Wolf&rsquo;s post-herpetic isotopic response may also occur, resulting in the development of immunity related skin disorders at the site of a previous herpetic eruption. Shingles is an HIV indicator condition, and<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4043,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1059],"class_list":["post-17735","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-recurrent-vesicular-rash"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/infectiousdiseases\/https-apps-nhslothian-scot-refhelp-recurrent-vesicular-rash\/\" rel=\"tag\">Recurrent Vesicular Rash<\/a>","rttpg_excerpt":"Recurrent shingles is rare (especially &ge; 2 episodes) and requires laboratory confirmation as other aetiologies such as recurrent zosteriform herpes simplex should be considered. Wolf&rsquo;s post-herpetic isotopic response may also occur, resulting in the development of immunity related skin disorders at the site of a previous herpetic eruption. Shingles is an HIV indicator condition, and","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17735","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=17735"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17735\/revisions"}],"predecessor-version":[{"id":27987,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/17735\/revisions\/27987"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4043"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=17735"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=17735"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}