Herpes Zoster (Shingles)
Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:
-- The first section of this topic is shown below --
- Results from reactivation of latent varicella-zoster virus (human herpesvirus type 3) infection
- Postherpetic neuralgia (PHN) is defined as pain persisting at least 1 month after rash has healed. The term zoster-associated pain is more clinically useful.
- Usually presents as a painful unilateral vesicular eruption with a dermatomal distribution
- System(s) affected: nervous; integumentary; exocrine
- Synonym(s): shingles
Predominant sex: male = female
- Incidence increases with age. 2/3 of cases occur in adults age ≥50 years. Incidence is increasing overall as the U.S. population ages.
- Herpes zoster: 4/1,000 person-years
- PHN: 18% in adult patients with herpes zoster; 33% in patients ≥79 years of age
Nearly 1 million new cases of herpes zoster annually
May occur during pregnancy
- Increased incidence of zoster outbreaks
- Increased incidence of PHN
- Occurs less frequently in children
- Has been reported in newborns infected in utero
Etiology and Pathophysiology
Reactivation of varicella-zoster virus from dorsal root/cranial nerve ganglia. Upon reactivation, the virus replicates within neuronal cell bodies, and virions are carried along axons to dermatomal skin zones, causing local inflammation and vesicle formation.
- Increasing age
- Immunosuppression (malignancy or chemotherapy)
- HIV infection
- Spinal surgery
- Herpes zoster vaccination (Shingrix) is recommended by the CDC for patients ≥50 years (1,2) to prevent shingles and related complications. Shingrix is recommended for adults who previously received Zostavax and is the preferred vaccine.
- Patients with active zoster may transmit disease-causing varicella virus (chickenpox) to susceptible persons.
Commonly Associated Conditions
Immunocompromised states HIV infection, posttransplantation, immunosuppressive drugs, and malignancy