Herpes Zoster (Shingles)

Mark B. Stephens, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Results from reactivation of latent varicella-zoster virus (human herpesvirus type 3) infection

  • Postherpetic neuralgia (PHN) is defined as pain persisting at least 1 month after rash ...

DIAGNOSIS

HISTORY

  • Prodromal phase (sensory changes over involved dermatome prior to rash)

    • Tingling, paresthesias

    • Itching

    • Boring “knife-like” pain

  • Acute phase

    • Constitutional symptoms (e.g., fatigue, mala...

TREATMENT

GENERAL MEASURES

  • Treat to control symptoms and prevent complications.

  • Antiviral therapy decreases viral replication, lessens inflammation, nerve damage, and reduces the severity and duration o...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Refer to ophthalmology if concern that ophthalmic branch of the trigeminal nerve is involved. 

Patient Monitoring

Follow duration of symptoms—particularly PHN. Cons...

REFERENCES

1 Hales CM, Harpaz R, Ortega-Sanchez I, et al; for Centers for Disease Control and Prevention. Update on recommendations for use of herpes zoster vaccine. MMWR Morb Mortal Wkly Rep.  ...

ADDITIONAL READING

  • Chen N, Li Q, Zhang Y, et al. Vaccination for preventing postherpetic neuralgia. Cochrane Database Syst Rev.  2011;(3):CD007795.  [View Abstract]

  • Langan SM, Smeeth L, Margolis ...

SEE ALSO

  • Bell Palsy; Chickenpox (Varicella Zoster); Herpes Eye Infections; Herpes Simplex

  • Algorithm: Genital Ulcers

CODES

ICD10

  • B02.9 Zoster without complications

  • B02.29 Other postherpetic nervous system involvement

ICD9

  • 053.9 Herpes zoster without mention of complication

  • 053.10 Herpes zoster with unspecified nervous sy...

CLINICAL PEARLS

  • Begin antiviral therapy within 72 hours of the onset of rash to be most effective.

  • Patients with active herpes zoster can transmit clinically active disease (chickenpox) to susceptible ...

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