Herpes Zoster (Shingles)

Robert J. Hyde, MD, MA Reviewed 06/2017
 


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, ...

TREATMENT

GENERAL MEASURES

  • Direct treatment to control symptoms and prevent complications

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

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

Hales  CM, Harpaz  R, Ortega-Sanchez  I, et al. Update on recommendations for use of herpes zoster vaccine. MMWR Morb Mortal Wkly Rep.  2014;63(33):729–731.  [View Abstract]
Schmader ...

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

  • Patients with herpes zoster should begin antiviral therapy within 72 hours of the onset of rash to be most effective.

  • Patients with active herpes zoster can transmit clinically active d...

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