Herpes Zoster (Shingles)
Symptoms
Shingles begins with localized pain, tingling, or burning followed by a unilateral vesicular rash in a dermatomal distribution. Vesicles cluster and eventually crust over 7–10 days. Fever and malaise may accompany the eruption. Postherpetic neuralgia—persistent nerve pain—can develop after rash resolution. Ophthalmic involvement threatens vision if the trigeminal branch is affected.
Cause
Varicella‑zoster virus remains dormant in dorsal root ganglia after childhood chickenpox. Reactivation occurs when cellular immunity wanes with aging, stress, or immunosuppression. The virus travels along sensory nerves to the skin, causing inflammation and blistering. Transmission of varicella (not shingles) can occur to susceptible individuals via direct contact. Vaccination reduces incidence and severity.
Treatment
Oral antivirals (acyclovir, valacyclovir, famciclovir) initiated within 72 hours hasten healing and lessen neuralgia risk. Analgesics, including neuropathic agents like gabapentin, manage pain. Corticosteroids may reduce acute discomfort and improve function in select cases. Cool compresses and calamine lotion soothe lesions. Postherpetic neuralgia is treated with topical lidocaine, capsaicin, or systemic agents.
Dr. Beth Schulz-Butulis
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