Herpes zoster is a painful viral infection caused due to varicella-zoster virus reactivation. 

Symptoms start with pain in dermatome, that leads to vesicular eruption within days, with painful grouped herpetiform vesicles. Painful grouped herpetiform vesicles on red base. 

Varicella-zoster virus reactivates from dorsal root ganglia decades after initial exposure to varicella. 

It usually causes a rash and pain but can lead to serious complications like postherpetic neuralgia and economic burden. 

Zoster commonly occurs due to immune system failure with latent VZV. Other triggers like radiation, trauma, meds, infections, and stress are uncertain. 

About 95% of U.S. adults and 99.5% of those >40 years old have antibodies to VZV. 

Most individuals who had chickenpox can get shingles, especially as they get older and immunodeficiency. 

Around 4% of patients experience later recurrences in immunosuppressed individuals. It is rare in children and young adults, common in those with AIDS, lymphoma, malignancies, immune deficiencies, or transplants. 

About 50% of herpes zoster patients experience complications. Ophthalmic complications risk does not correlate with age, sex, or rash severity. 

VZV infection causes chickenpox and shingles both distinct and contagious syndromes. 

The host immune system suppresses viruses, Cutaneous rash from herpes zoster coincides with VZV-specific T-cells, followed but to interferon alfa production post-recovery. but VZV reactivates when containment fails. 

Herpes zoster primarily affects dorsal root ganglia but can spread to CNS areas. 

In very sick or immunocompromised patients, CNS involvement may present as meningoencephalitis or encephalitis. 

VZV infection causes herpes zoster, a disease from the Herpesviridae family with 70 encoded proteins. 

Initial VZV infection in humans happens through contact with respiratory or conjunctiva mucosa. 

VZV reactivation from dorsal root ganglia after initial varicella exposure causes herpes zoster. 

Cellular immunity decline raises reactivation risk with age and immunocompromised individuals. 

Good prognosis for younger, healthy patients, and higher risk for elderly complications. 

Rarely fatal in healthy individuals, but it may be life-threatening for vulnerable patients. 

Morbidity typically limited to varying levels of pain in dermatome. 

Patients with lymphoproliferative malignancies have 5-15% mortality risk from disseminated herpes zoster. 

Herpes zoster affects older adults in individuals more than age of 50 years old.  

Inspection for Rash and Lesions 

Neurological Examination 

Red patches in affected area progress to clusters of blisters in 1-2 days. Severe acute neurotic pain accompanies rash, described as burning and stabbing, that impact patient’s quality of life. 

Treatment most effective for immunocompromised individuals and those >50 years old with severe or prolonged symptoms. 

Transfer sick patients with advanced disease or compromised immunity to specialized care. 

The topical treatments, including topical acyclovir cream, lidocaine, and capsaicin. 

Acute herpes zoster causes pain that is usually the most severe symptom for patients. 

Limited studies on specific treatments for acute zoster-associated pain despite established effectiveness for general neuropathic pain. 

Consider nonpharmacologic therapies like nerve blocks and electrical stimulation for acute zoster pain. 

Antiviral therapy shortens time for vesicle formation, crusting attainment, and acute discomfort during infection. 

Antiviral treatment can stop the spread of acute herpes zoster in immunocompromised patients starting even after 72 hours. 

Dermatology, General

Lifestyle modification like intake of healthy nutritional supplements and proper hydration should be followed by patients. 

Proper education and awareness about herpes zoster should be provided and its related causes, and how to stop it with management strategies. 

Consistent using emollients maintains hydration to prevent cracking and apply sunscreen on skin. 

Appointments with a dermatologist and preventing recurrence of disorder is an ongoing life-long effort. 

Dermatology, General

Acyclovir: 

It is a synthetic purine nucleoside analogue, that inhibits human herpes viruses including HSV-1, HSV-2, VZV, Epstein-Barr, and CMV. 

Famciclovir:  

It turns into penciclovir when consumed and activated by viral thymidine kinase. 

Dermatology, General

Prednisone: 

It requires metabolization to active prednisolone metabolite, potentially impaired in liver disease. 

Dermatology, General

Capsaicin from Solanaceae plants is a TRPV1 agonist used for neuropathic pain like PHN. 

Dermatology, General

Oxycodone:  

It is used for moderate to severe pain relief, common in patients with herpes zoster. 

Ibuprofen:  

It is a NSAID used for mild to moderate pain treatment when there are no contraindications. 

Dermatology, General

Gabapentin: 

It acts on α2δ1 and α2δ2 subunits of calcium channels to treat neuropathic pain and provide sedation. 

Dermatology, General

Amitriptyline: 

It inhibits spinal neurons to reduce pain perception effectively. 

Dermatology, General

Surgical care is not indicated, but it may be required to treat certain complications. E.g., necrotizing fasciitis  

Rhizotomy is surgical separation of pain fibers that may be indicated in cases of intractable pain. 

Dermatology, General

In acute phase, initiate antiviral therapy within 72 hours then manage pain and provide skin care to patient. 

In chronic phase, focus should be on managing chronic pain for improving quality of life includes use of pharmacological and non-pharmacological therapies. 

The regular follow-up visits with the dermatologist are schedule to check the improvement of patients along with treatment response.