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Herpes Zoster Resource Center
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Herpes zoster (shingles) is 1 of 2 distinctive manifestations of human infection with the varicella-zoster virus (VZV), the other being varicella (chickenpox). Chickenpox is a common and generally benign illness of childhood that is characterized by an exanthematous vesicular rash. Following resolution of this primary infection, VZV becomes latent in dorsal root ganglia until such time when a decrease in cellular immunity triggers the reactivation of the virus. |
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Zoster is a common, predominantly dermal, and neurologic disorder caused by the varicella-zoster virus. The manifestation of zoster results in pain and characteristic cutaneous findings along the corresponding sensory dermatomes of the involved ganglia.
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Most patients who develop zoster have a 2- to 3-day prodrome of pain, tingling, or burning in the involved dermatome. The primary physical finding is a rash in a unilateral dermatomal distribution; the rash may be erythematous, vesicular, pustular, or crusting, depending on the stage of disease. In the ED, diagnosis of herpes zoster is based primarily on clinical findings. However, in some patients, the presentation of herpes zoster can be atypical and may require additional testing.
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Herpes zoster typically manifests as a vesicular rash in a unilateral dermatomal distribution associated with pain. The clinical manifestations of herpes zoster can be divided into the pre-eruptive phase (preherpetic neuralgia), acute eruptive phase, and chronic phase (postherpetic neuralgia). Incidence of herpes zoster increases with age, presumably through the general decrease in immune function that occurs with aging.
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Herpes zoster ophthalmicus involves the tissues innervated by the ophthalmic division of the trigeminal nerve and accounts for 10-25% of all cases of shingles. The sequelae of herpes zoster ophthalmicus can be devastating and include chronic ocular inflammation, visual loss, and debilitating pain.
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Varicella-zoster virus infection is an acute neurologic disease that warrants immediate evaluation. A spectrum of signs and symptoms can occur, including a self-limited painful rash, pain without skin manifestations, keratitis, vertigo, and spinal cord disease with weakness. Inflammatory involvement may include the leptomeninges. When the cervical and lumbar roots are involved, motor involvement may be seen, depending on the virulence and/or extent of migration.
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A Vaccination Study to Evaluate the Safety and Immune Response of the GSK Biologicals Zoster Vaccine, GSK1437173A, and to Compare 3 Dosages of GSK1437173A in Healthy Elderly Subjects, Aged 60 Years and Above |
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Dose-Finding Study of ASP2151 in Subjects With Herpes Zoster- A Multicenter, Randomized, Double-Blind, Valacyclovir Hydrochloride-Controlled, Parallel-Group, Comparative Study
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Placebo-Controlled Study of Pregabalin for the Pain of Acute Herpes Zoster
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An Extension Study to Evaluate the Persistence of the Immune Responses Induced by GSK Biologicals Zoster Vaccine, GSK324332A, Administered in Healthy Adult Subjects Aged 18-30 Years and 50-70 Years
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A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group With a Crossover Confirmation Period Study of RWJ-333369 for the Treatment of Postherpetic Neuralgia.
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Feller L, Wood NH, Lemmer J. Herpes zoster infection as an immune reconstitution inflammatory syndrome in HIV-seropositive subjects: A review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Jun 27; [Epub ahead of print] |
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Schmader KE, Sloane R, Pieper C, Coplan PM, Nikas A, Saddier P, Chan IS, Choo P, Levin MJ, Johnson G, Williams HM, Oxman MN. The Impact of Acute Herpes Zoster Pain and Discomfort on Functional Status and Quality of Life in Older Adults. Clin J Pain. 2007 July/August;23(6):490-496. |
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Burke MS. Herpes zoster vaccine: clinical trial evidence and implications for medical practice. J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S14-8. |
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Galluzzi KE. Management strategies for herpes zoster and postherpetic neuralgia. J Am Osteopath Assoc. 2007 Mar;107(3 Suppl 1):S8-S13. |
