Herpes zoster infection

Last reviewed: 27 Oct 2022
Last updated: 10 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • localised pain in a dermatome
  • pruritus
  • rash
  • corneal ulceration
More key diagnostic factors

Other diagnostic factors

  • fever
  • headache
  • malaise
  • fatigue
  • pain without rash
Other diagnostic factors

Risk factors

  • >50 years of age
  • female sex
  • HIV
  • chronic corticosteroid use
  • chemotherapy
  • malignancies
  • white ethnicity
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • polymerase chain reaction (PCR)
  • immunohistochemistry
  • vesicular fluid culture
  • HIV test
More investigations to consider

Treatment algorithm

ACUTE

acute symptoms: immunocompetent

acute symptoms: immunocompromised

ONGOING

postherpetic pain

Contributors

Authors

Phuc Le, PhD, MPH

Assistant Professor

Center for Value-Based Care Research

Medicine Institute

Cleveland Clinic

Cleveland

OH

Disclosures

PL declares that she has no competing interests.

Michael Rothberg, MD, MPH

Professor

Center for Value-Based Care Research

Medicine Institute

Cleveland Clinic

Cleveland

OH

Disclosures

MR declares that he has no competing interests.

Acknowledgements

Dr Phuc Le and Dr Michael Rothberg would like to gratefully acknowledge Dr Kenneth J. Smith and Dr Linda Kalilani, the previous contributors to this topic.

Disclosures

KJS and LK declare that they have no competing interests.

Peer reviewers

Julius Atashili, MD, MPH

Department of Epidemiology

Division of General Medicine and Epidemiology

UNC at Chapel Hill

Chapel Hill

NC

Disclosures

JA declares that he has no competing interests.

Ken Mutton, MB, BS, FRCPA, FRCPath

Consultant Virologist

Manchester Royal Infirmary

Manchester

UK

Disclosures

KM declares that he has no competing interests.

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