From the Guidelines
Herpes zoster, also known as shingles, is a painful, vesicular, cutaneous eruption caused by the reactivation of the varicella zoster virus (VZV) that typically occurs in adults or the elderly when the cellular immune response fails to control the latent replication of VZV.
Course of the Disease
- The disease manifests by a unilateral, vesicular eruption with dermatomal pain that often precedes the skin findings by 24-72 hours (and sometimes longer) 1.
- Early lesions are erythematous macules that rapidly evolve to papules and then to vesicles, which frequently coalesce, form bullae, and scab before healing 1.
- The entire disease duration is approximately 2 weeks in otherwise healthy hosts, but may be longer in immunocompromised hosts, with skin lesions continuing to develop over a period of 7-14 days and healing more slowly unless effective antiviral therapy is administered 1.
Complications
- Postherpetic neuralgia (PHN) is the most common complication of herpes zoster, particularly in older persons, and is characterized by the persistence of sometimes debilitating pain weeks to months after resolution of the disease 1.
- Other complications include herpes ophthalmicus, which can lead to blindness, and dissemination, which might involve generalized skin eruptions, and central nervous system, pulmonary, hepatic, and pancreatic complications, typically restricted to immunocompromised persons 1.
Treatment
- High-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts, while oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts 1.
From the Research
Course of Herpes Zoster (Shingles) Disease
The course of Herpes zoster (shingles) disease is characterized by several stages, including:
- Reactivation of varicella-zoster virus that has been dormant in the spinal and cranial sensory ganglia following primary infection with varicella (chickenpox) 2
- Appearance of a vesicular rash, usually unilateral and confined to a single dermatome, which typically progresses to clear vesicles that become cloudy and crust over in 7-10 days 3
- Acute symptoms such as pain, malaise, headache, and low-grade fever, which can last for several weeks 4, 3
- Potential development of postherpetic neuralgia (PHN), a debilitating and difficult to manage consequence of HZ, defined as pain persisting more than 3 months after the rash has healed 4, 5, 3
Risk Factors and Complications
The risk of developing HZ increases with age, with approximately 50% of those aged 80 years or more affected 2
- Complications of HZ can be neurological, ophthalmological, dermatological, or visceral, and may include visual disturbances, severe itching, and allodynia 2, 6
- PHN is the most common complication, occurring in about one in five patients, and can have a significant impact on quality of life 3
Treatment and Prevention
Treatment of HZ typically involves antiviral drugs and analgesics, which can reduce acute symptoms and may also reduce PHN 2, 4, 3
- A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is available and recommended for adults older than 60 years 5, 3, 6
- The vaccine has been shown to reduce significantly the incidence of both HZ and PHN, and is well tolerated with minor local injection site reactions being the most common adverse event 5