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Herpes Zoster (Shingles)

Herpes Zoster (Shingles) is a topic covered in the 5-Minute Clinical Consult.

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  • 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

Pregnancy Considerations
May occur during pregnancy

Geriatric Considerations
  • Increased incidence of zoster outbreaks
  • Increased incidence of PHN
Pediatric Considerations
  • 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.

Risk Factors

  • Increasing age
  • Immunosuppression (malignancy or chemotherapy)
  • HIV infection
  • Spinal surgery

General Prevention

  • 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

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Stephens, Mark B., et al., editors. "Herpes Zoster (Shingles)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816906/all/Herpes_Zoster__Shingles_.
Herpes Zoster (Shingles). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816906/all/Herpes_Zoster__Shingles_. Accessed March 22, 2019.
Herpes Zoster (Shingles). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816906/all/Herpes_Zoster__Shingles_
Herpes Zoster (Shingles) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 22]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816906/all/Herpes_Zoster__Shingles_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Herpes Zoster (Shingles) ID - 816906 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816906/all/Herpes_Zoster__Shingles_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -