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Herpes Zoster (Shingles)

Shane L. Larson, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

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

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

DIAGNOSIS

HISTORY

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

    • Tingling, paresthesias

    • Itching

    • Boring “knife-like” pain

    • Allodynia and hyperalgesia

  • Acute phase

    • Constitutional symptom...

TREATMENT

GENERAL MEASURES

  • Treat to control symptoms and prevent complications.

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

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
Centers for Disease Control and Prevention. Shingles (herpes zoster). https://www.cdc.gov/shingles/vaccination.html. Accessed December 22, 2019.
2
Saguil A, Kane S, Mercado M, et al. Herpes ...

ADDITIONAL READING

Langan SM, Smeeth L, Margolis DJ, et al. Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: a cohort study. PL...

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

  • Antiviral therapy within 72 hours of the onset of rash is most effective.

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

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