Summary
Definition
History and exam
Key diagnostic factors
- localized pain in a dermatome
- pruritus
- rash
- corneal ulceration
Other diagnostic factors
- fever
- headache
- malaise
- fatigue
- pain without rash
Risk factors
- >50 years of age
- female sex
- HIV
- chronic corticosteroid use
- chemotherapy
- malignancies
- white ethnicity
- certain acute or chronic conditions
- vaccination against other infectious diseases
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- polymerase chain reaction (PCR)
- immunohistochemistry
- vesicular fluid culture
- HIV test
Treatment algorithm
acute symptoms: immunocompetent
acute symptoms: immunocompromised
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.
References
Key articles
Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007 Jan 1;44 Suppl 1:S1-26.Full text Abstract
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: varicella-zoster virus. 2022 [internet publication].Full text
Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018 Jan 26;67(3):103-8.Full text Abstract
Centers for Disease Control and Prevention. Adult immunization schedule by age. Recommendations for ages 19 years or older, United States, 2025. Nov 2024 [internet publication].Full text
Severson EA, Baratz KH, Hodge DO, et al. Herpes zoster ophthalmicus in Olmsted County, Minnesota: have systemic antivirals made a difference? Arch Ophthalmol. 2003 Mar;121(3):386-90.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Contact dermatitis
- Herpes simplex
- Cholecystitis
More DifferentialsGuidelines
- Recommended immunization schedule for adults aged 19 years or older: United States, 2025
- Update on recommendations for use of herpes zoster vaccine
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