6th July 2023

Herpes Zoster (Shingles)

A self-limiting blistering rash caused by the reactivation of the varicella zoster virus (VZV), also known as human herpesvirus type 3 (HHV3). Chickenpox is the acute, primary infection which produces widespread lesions at different stages of development. The virus remains dormant in the dorsal root ganglion in the spinal cord and, when reactivated, migrates down cutaneous sensory nerves to induce lesions.

Herpes zoster (shingles) 

Image Source: Wikimedia Commons (2007). Herpes zoster chest, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Herpes_zoster_chest.png (Accessed on: 10 March 2022).

Prior to the skin changes, there may be localised pain associated with fever and tender lymphadenopathy. Red papules then erupt into vesicles in a unilateral dermatomal distribution and are confined to the distribution of one or two sensory nerves. Commonly affects the face, neck and trunk. Involvement of the ophthalmic division of the trigeminal nerve is termed herpes zoster ophthalmicus, and involvement of the VII nerve is termed Ramsay Hunt syndrome. Lesions can take up to a month to resolve.

Herpes zoster is self-limiting and management can include analgesia and emollients. Oral antivirals can be commenced in more vulnerable patients presenting <72 hours from onset or severe cases. Complications include corneal scarring, Ramsay Hunt syndrome and post-herpetic neuralgia. The preventive shingles vaccine is offered in the UK to individuals over 70 years old.