Tzanck Preparation

Tzanck Preparation



Tzanck preparation is a rapid test done to diagnose infections caused by herpesviruses. Cells are examined under a microscope for signs of infection.


Herpesviruses are responsible for several superficial infections. Varicella zoster virus causes chickenpox and shingles, herpes simplex type 1 causes the common cold sore or fever blister, and herpes simplex type 2 causes the sexually transmitted disease genital herpes. They are all characterized by blisters and ulcers.
Physicians usually can diagnose herpes infections simply by looking at the type of blisters and ulcers, and their distribution on the person's body. Sometimes laboratory evidence of herpes is needed to confirm the diagnosis. For example, herpes can be devastating to a newborn baby or a person with a weakened immune system. Treatment can begin once herpes is confirmed in a laboring mother's genital ulcers or in the skin blisters of an immunocompromised person. A lab tries to grow (culture) the virus that may be present in the blister. This lab test takes several days to complete, but the Tzanck preparation takes minutes.


The Tzanck preparation is done by smearing cells taken from a fresh blister or ulcer onto a microscope slide. The cells are stained with a special stain, such as Wright's stain, and then examined under a microscope for characteristic changes caused by a herpesvirus. Herpes causes giant cells with multiple nuclei. The shape of each nucleus appears molded to fit together with those adjacent. The background of the cell looks like ground glass and contains small dark spots called inclusion bodies.
Tzanck preparation is also called a Tzanck smear, herpes stain for inclusion bodies, or inclusion bodies stain. Results are available the same or following day, often within minutes.


A fresh blister is opened with a scalpel or sterile needle. The physician scrapes the base of the blister with the scalpel, gathers as much cellular material as possible, and gently spreads it on a microscope slide.

Normal results

A normal smear shows no evidence of a herpes infection. This test may also have false negatives. Studies have shown that the Tzanck preparation shows signs of infection in only 50-79% of people with a herpes infection. A negative Tzanck preparation may have to be confirmed by a herpes culture.

Abnormal results

A smear that shows evidence of herpes infection does not distinguish between the various infections caused by herpes virus. The physician uses the person's symptoms and other clinical findings to distinguish between these infections. In certain cases, the physician will follow a positive Tzanck smear with a culture for confirmation.

Key terms

Herpes — A family of viruses including herpes simplex types 1 and 2, and herpes zoster (also called varicella zoster). Herpes viruses cause several infections, all characterized by blisters and ulcers, including chickenpox, shingles, genital herpes, and cold sores or fever blisters.



Henry, John B., editor. Clinical Diagnosis and Management by Laboratory Methods. 19th ed. Philadelphia: W. B. Saunders Co., 1996.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
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Clinical diagnosis should be confirmed by laboratory evaluation, typically Tzanck preparation, DFA, and/or HSV PCR.
We performed a Tzanck preparation, which showed multinucleated giant keratinocytes with nuclear molding and margination (online Appendix Figure, available from
To confirm the clinical diagnosis, a Tzanck preparation can be made of a scraping from the central core of an umbilicated lesion.
* Tzanck preparation can't be used to differentiate HSV and herpes zoster because it will demonstrate multinucleated giant cells in both cases.
Another useful bedside test is a Tzanck preparation which helps differentiate TEN from SSSS by showing cuboidal cells with a high nuclear cytoplasmic ratio in the former and wide epithelial cells with a low nuclear/cytoplasmic ratio in the latter.
Diagnosis of herpes virus infections: correlation of Tzanck preparations with viral isolation.