Which statement best describes the difference between herpes zoster and herpes simplex on peristomal skin?

• A. Herpes zoster can erupt along skin attached to a dermatome.
• B. Herpes zoster cannot affect peristomal skin.
• C. Herpes zoster is bacterial and herpes simplex is viral.
• D. Zoster only occurs on mucous membranes.

Answer: (A)

Herpes zoster tends to appear in a band that follows a single sensory nerve’s distribution. This dermatomal pattern means the vesicular outbreak can travel along the skin area served by one nerve and often stays unilateral, which is the hallmark that differentiates it from other herpes infections. On peristomal skin, you’d expect to see a strip or arc of lesions aligned with that nerve’s dermatome, reflecting reactivation in a dorsal root ganglion.

Herpes simplex, while also a herpesvirus, does not show this same dermatomal banding. Its lesions are typically clusters of vesicles on the lips, genitals, or other mucocutaneous junctions and do not spread in a single nerve-to-nerve stripe across the skin. HSV can involve peristomal skin, but the distribution isn’t characteristically dermatomal.

The other statements are inaccurate because zoster can affect peristomal skin, it is viral (not bacterial), and it is not limited to mucous membranes.