Herpes zoster

At a Glance

Herpes zoster (shingles) is a painful rash infection caused by the varicella-zoster virus (VZV).

Usually, burning, stabbing pain or itching appears first on one side of the body or face, followed by a band-shaped vesicular rash.

How the disease works

It occurs when VZV remaining in the body after chickenpox reactivates, with aging and immunosuppression being related factors.

It is understood that the reactivated virus moves to the sensory nerves and skin, causing nerve inflammation and localized rash and pain.

Variations in presentation among individuals

Anyone who has had chickenpox can develop it, but the risk is higher in the elderly and those with weakened immunity due to HIV, cancer, or immunosuppressive treatments.

The broad framework of diagnosis and management

Blisters usually scab over in 7–10 days, and postherpetic neuralgia (PHN), where pain persists for several weeks or longer after the rash, can occur; rarely, complications involving the eyes, ears, or nervous system may occur.

Diagnosis centers on a clinical evaluation that synthesizes symptoms, medical history, and the distribution of the rash; in uncertain cases, this can be supplemented by testing blister fluid or lesion specimens.

Current status of treatment

If only initial pain is present or if the rash is atypical, it may be confused with other diseases. In immunocompromised individuals, the rash may spread widely, so the location of complications and immune status must be interpreted together.

The key to management is early evaluation, determining whether antiviral treatment is needed, alleviating pain and itching, and monitoring for involvement of the eyes, ears, and nervous system, as well as postherpetic neuralgia (PHN).

There is no single curative treatment, but antivirals can help reduce the duration and severity of the disease. It is advised that they are most effective when administered as early as possible after the rash appears.

How to read clinical trials

Even after the rash has improved, persistent pain, changes in vision, hearing or balance problems, or facial weakness must be monitored. Effectiveness or whether a treatment is standard cannot be determined by clinical trial registration or completion status alone.

Points to verify during clinical consultations

In clinical practice, the timing and location of rash onset, severity of pain, history of varicella/vaccination, immunosuppressive factors, eye/ear symptoms, existing medications, and concerns about PHN can be assessed.