Herpes zoster

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Adult dermatome	Herpes zoster (shingles), disseminated	Herpes zoster (shingles) - close-up of lesion	Herpes zoster (shingles) on the arm
Herpes zoster (shingles) on the back	Herpes zoster (shingles) on the back	Herpes zoster (shingles) on the chest	Herpes zoster (shingles) on the hand
Herpes zoster (shingles) on the hand and fingers	Herpes zoster (shingles) on the neck and cheek	Shingles

Shingles

Herpes zoster usually disappears on its own, and may not require treatment except for symptom relief, such as pain medication.

Acyclovir is an antiviral medication that may be prescribed to shorten the course, reduce pain, reduce complications, or protect an immunocompromised individual. Desciclovir, famciclovir, valacyclovir, and penciclovir are similar to acyclovir and may be used to treat herpes zoster.

For the greatest effect, treatment with acyclovir-like medications should start within 24 hours of the appearance of pain or burning sensation, and preferably before the appearance of the characteristic blisters.

Typically, the drugs are given as pills, in doses four times greater than those recommended for herpes simplex or genital herpes. Severely immunocompromised individuals may require intravenous (IV) acyclovir therapy.

Corticosteroids, such as prednisone, may occasionally be used to reduce inflammation and risk of post-herpetic neuralgia. They have been shown to be most effective in the elderly population. Corticosteroids have certain risks that should be considered before using them.

Pain medicines (analgesics) , mild to strong, may be needed to control pain. Antihistamines may be used topically (direct application to the body) or orally (by mouth) to reduce itching. Zostrix, a cream containing capsaicin (an extract of pepper), may prevent post-herpetic neuralgia.

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or lotions and calamine lotion, may help to relieve itching and discomfort. Resting in bed until the fever goes down is recommended.

The skin should be kept clean, and contaminated items should not be re-used. Non-disposable items should be washed in boiling water or otherwise disinfected before re-use. The person may need to be isolated while lesions are oozing to prevent infection of others -- especially pregnant women.

Herpes zoster usually clears in 2 to 3 weeks and rarely recurs. Involvement of motor nerves (nerves that control movement) may cause temporary or permanent nerve palsy (weakness or paralysis). Neuralgia (continued nerve pain) may persist for years in 50% of those over 60 years old who have shingles, particularly if the trigeminal nerve was affected. Eye lesions may lead to permanent blindness and require emergency medical care.

• Post herpetic neuralgia
• Secondary bacterial skin infections
• Recurrence (rare)
• Generalized infection, visceral organ lesions, encephalitis or sepsis in immunosuppressed persons
• Blindness (if lesions occur in the eye)
• Deafness
• Loss of taste
• Facial paralysis

Call your health care provider if the symptoms indicate herpes zoster, particularly if you are immunosuppressed or if symptoms persist or worsen.

Review Date: 05/26/2006
Reviewed By: Monica Gandhi MD, MPH, Assistant Professor, Division of Infectious Diseases, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.