From the Guidelines
Herpes Zoster, also known as Shingles, is a painful, vesicular, cutaneous eruption caused by the reactivation of varicella zoster virus (VZV), which can lead to potentially debilitating complications.
Definition and Epidemiology
Herpes Zoster is estimated to have a lifetime risk of 20%–30% in the general population, with an increased risk in the elderly and immunocompromised populations 1. The most effective strategy to prevent Herpes Zoster and its complications is by vaccination, with two types of vaccines, zoster vaccine live and recombinant zoster vaccine, approved for use 1. Some key points about Herpes Zoster include:
- It is a painful rash caused by reactivation of the varicella-zoster virus
- The risk of Herpes Zoster increases with age and in immunocompromised populations
- Vaccination is the most effective strategy to prevent Herpes Zoster and its complications
Prevention and Treatment
For prevention, the recombinant zoster vaccine is recommended for adults, given as two doses 2-6 months apart, even if you've had shingles before or received the older Zostavax vaccine. In terms of treatment, antiviral medications started within 72 hours of rash onset, including valacyclovir, famciclovir, or acyclovir, are recommended, along with pain management, which may include acetaminophen, NSAIDs, or in severe cases, prescription medications like gabapentin or pregabalin 1. Some key points about prevention and treatment include:
- The recombinant zoster vaccine is recommended for adults
- Antiviral medications should be started within 72 hours of rash onset
- Pain management is crucial and may include various medications
Quality of Life and Morbidity
Early treatment is essential as it reduces the duration and severity of the outbreak and lowers the risk of postherpetic neuralgia, a condition where pain persists for months or years after the rash heals 1. Keeping the rash clean and covered can help prevent spreading the virus to others who haven't had chickenpox. Some key points about quality of life and morbidity include:
- Early treatment can reduce the duration and severity of the outbreak
- Postherpetic neuralgia is a potential complication of Herpes Zoster
- Keeping the rash clean and covered can help prevent spreading the virus to others
From the Research
Definition and Cause of Herpes Zoster
- Herpes zoster, commonly referred to as "shingles," results from the reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox 2.
- The varicella-zoster virus resides in the dorsal root ganglia and can reactivate, causing the classic dermatomal rash and pain associated with herpes zoster 3, 4.
Risk Factors and Complications
- Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies, and chronic corticosteroid use, may increase the risk of developing herpes zoster 2.
- Postherpetic neuralgia is a common complication of herpes zoster, characterized by pain that persists for more than 90 days after the acute herpes zoster rash has resolved 4, 5, 6.
- Ocular involvement in herpes zoster can lead to rare but serious complications and may require referral to an ophthalmologist 2.
Treatment and Management
- Herpes zoster is usually treated with orally administered antiviral medications, such as acyclovir, valacyclovir, or famciclovir, ideally within 72 hours of the onset of the rash 2, 3, 4, 5, 6.
- The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 2.
- Treatment for postherpetic neuralgia may include topical lidocaine or capsaicin, oral gabapentin, pregabalin, or tricyclic antidepressants, and opioid analgesics in some cases 4, 5, 6.
Prevention
- The varicella zoster virus vaccine can decrease the incidence of herpes zoster and is approved for adults 50 years and older 4, 5, 6.
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends the vaccine for adults 60 years and older, except for certain immunosuppressed patients 4.