What are the clinical features of shingles?

From the Guidelines

Shingles is identified by a painful, unilateral rash with a dermatomal distribution, typically on the trunk or face, and is characterized by prodromal symptoms, erythematous macules, papules, and grouped vesicles that crust over and heal within 2-4 weeks, as described in the most recent study 1. The clinical features of shingles begin with prodromal symptoms including localized pain, burning, tingling, or itching in the affected area 1-5 days before the rash appears.

• The characteristic rash starts as erythematous macules and papules that rapidly evolve into grouped vesicles on an erythematous base.
• These vesicles eventually crust over within 7-10 days and completely heal within 2-4 weeks.
• Patients often experience moderate to severe pain described as sharp, stabbing, or burning.
• Other symptoms may include fever, headache, malaise, and regional lymphadenopathy. In some cases, particularly in older or immunocompromised individuals, complications can occur including postherpetic neuralgia (persistent pain after the rash resolves), bacterial superinfection, motor neuropathy, or ophthalmic involvement if the trigeminal nerve is affected, as noted in 1. Shingles results from reactivation of the varicella-zoster virus (VZV) that has remained dormant in sensory ganglia following a primary chickenpox infection, often triggered by factors such as aging, stress, or immunosuppression, as explained in 1. The most effective strategy to prevent varicella, HZ, and its related complications is by vaccination, according to the most recent guidance 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Clinical Features of Shingles

The clinical features of shingles can be identified by the following characteristics:

• Pain or discomfort in the involved dermatome, usually without constitutional symptoms 2
• Local edema and erythema appear before the development of a rash 2
• Maculopapular and vesicular rash that evolves into crusts 2
• The most commonly involved ganglia are lumbar, thoracic, sacral posterior root ganglia, then geniculate ganglion of the VIIth cranial nerve and the trigeminal ganglion 2

Complications of Shingles

Shingles can lead to several complications, including:

• Postherpetic neuralgia, which may last for several weeks, months, or even years 2, 3
• Ocular complications such as keratitis, iridocyclitis, secondary glaucoma, and loss of sight 2
• Neurological complications such as various motor neuropathies, encephalitis, and Guillain-Barre syndrome 2
• Secondary bacterial infection of vesicles 2

Atypical Presentations of Shingles

Shingles can also present atypically, such as:

• Painless herpes zoster in an elderly male 4
• Shingles mimicking acute abdomen 5

Diagnosis and Treatment of Shingles

The diagnosis of shingles is usually made by history and physical examination 2

• Antiviral medications such as aciclovir, famciclovir, and valaciclovir can be used to treat shingles 2, 3, 6
• Corticosteroids may be used in combination with antiviral medications to improve the quality of life of older patients 3