Herpes Zoster Shingles

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Etiology: Varicella zoster virus (VZV) causes chickenpox; after primary infection, VZV remains dormant in sensory nerve roots for life, and reactivation results in herpes zoster (shingles). Reactivation may be idiopathic, but may occur with immunosuppression or stress. Increased incidence with increasing age; more common in HIV & hematologic malignancy.

History: Pain/tenderness in a unilateral dermatomal distribution often precedes rash.

Physical: W/i 3—4 d of onset of symptoms, clusters of erythema-tous papules and vesicles develop in a dermatomal distribution (thoracic > cranial > lumbar); new groups of lesions continue to appear over several days, eventually followed by crusting and desquamation over a 2—4-wk period. Generalized zoster: Lesions involve several nonadjacent dermatomes and cross the midline. Complications: Post-herpetic neuralgia (PHN), scarring, secondary bacterial infection. PHN occurs in 50% of pts > 60 yr, & is present at 1 yr in 10% — 25%; characterized by shooting or burning pain in the previously involved sites; more common in older patients and when the trigeminal nerve is involved.

Investigations: Diagnosis is mostly clinical; if unsure, same work-up as for chickenpox and biopsy can be helpful.

DDx: VZV, herpes simplex, folliculitis.

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