Herpes zoster 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.
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. 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.
History and exam
Key diagnostic factors
- localized pain in a dermatome
- corneal ulceration
Other diagnostic factors
- pain without rash
- >50 years of age
- female sex
- chronic corticosteroid use
- white ethnicity
1st investigations to order
- clinical diagnosis
Investigations to consider
- polymerase chain reaction (PCR)
- vesicular fluid culture
- HIV test
acute symptoms: immunocompetent
acute symptoms: immunocompromised
Phuc Le, PhD, MPH
Center for Value-Based Care Research
PL declares that she has no competing interests.
Michael Rothberg, MD, MPH
Center for Value-based Care Research
MR declares that he has no competing interests.
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.
Julius Atashili, MD, MPH
Department of Epidemiology
Division of General Medicine and Epidemiology
UNC at Chapel Hill
JA declares that he has no competing interests.
Ken Mutton, MB, BS, FRCPA, FRCPath
Manchester Royal Infirmary
KM declares that he has no competing interests.
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