Herpes zoster is an unusual condition in pediatrics caused by reactivation of latent varicella virus. It presents most often in children who are immune suppressed, who had chickenpox when younger than age 1 year, or who contracted the virus transplacentally. When zoster appears in the distribution of cranial nerve V1, herpes zoster ophthalmicus often occurs. Practitioners should know how to diagnose and treat this condition.

Clinically, the physician should be alerted to zoster in the region of the face extending from the level of the eye to the vertex of the skull. This is the region innervated by cranial nerve V1, the ophthalmic nerve. Zoster lesions on the tip or side of the nose are called the Hutchinson sign and are highly associated with herpetic eye involvement. This is because the same branch of the ophthalmic nerve that innervates the eye, the nasociliary nerve, also innervates the nose.