Herpes zoster infection

Last reviewed: May 2019

Last updated: July 2018

Summary

Typically presents with pain described as burning or stabbing, followed by a vesicular rash in the affected dermatome; location of symptoms depends on the affected nerve.

Diagnosis is primarily based on the typical clinical symptoms, such as dermatomal pain and eruption of grouped vesicles in the same dermatome. Confirmation can be done using polymerase chain reaction (PCR) methods.

Treatment is primarily to reduce pain using analgesics and viral replication using antiviral medication such as acyclovir.

Antiviral therapy may reduce the severity of postherpetic neuralgia. Early antiviral therapy is particularly important in ophthalmic zoster and zoster in the immunocompromised.

Definition

Herpes zoster (HZ), caused by reactivation of varicella-zoster virus (VZV) that was acquired during a primary varicella infection, is characterized by dermatomal pain and papular rash. [1] The pain typically precedes the rash by several days and can persist for several months after the rash resolves. The rash usually presents in a single dermatome and typically resolves within 4 to 5 weeks. A common complication is postherpetic pain. [2]

History and exam

Key diagnostic factors

localized pain in a dermatome
pruritus
rash
corneal ulceration

Full details

Other diagnostic factors

fever
headache
malaise
fatigue
pain without rash

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Risk factors

>50 years of age
HIV
chronic corticosteroid use
chemotherapy
malignancies
white ethnicity

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Diagnostic investigations

1st investigations to order

clinical diagnosis

Full details

Investigations to consider

polymerase chain reaction (PCR)
immunohistochemistry
vesicular fluid culture

Full details

Treatment algorithm

ACUTE

acute symptoms: immunocompetent

acute symptoms: immunocompromised

ONGOING

postherpetic pain

Contributors

Authors VIEW ALL 

Phuc Le, PhD, MPH

Assistant Professor

Center for Value-Based Care Research

Medicine Institute

Cleveland Clinic

Cleveland

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

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. KJS and LK declare that they have no competing interests.

Peer reviewers VIEW ALL 

Julius Atashili, MD, MPH

Department of Epidemiology

Division of General Medicine and Epidemiology

UNC at Chapel Hill

Chapel Hill

Disclosures

JA declares that he has no competing interests.

Ken Mutton, MB, BS, FRCPA, FRCPath

Consultant Virologist

Manchester Royal Infirmary

Manchester

Disclosures

KM declares that he has no competing interests.

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Herpes zoster infection

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

acute symptoms: immunocompetent

acute symptoms: immunocompromised

postherpetic pain

Contributors

Authors VIEW ALL 

Phuc Le, PhD, MPH

Disclosures

Michael Rothberg, MD, MPH

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Julius Atashili, MD, MPH

Disclosures

Ken Mutton, MB, BS, FRCPA, FRCPath

Disclosures

Differentials

Guidelines

Patient leaflets

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