55 Herpes Zoster infection

Herpes Zoster Infection

Herpes zoster (shingles) occurs from reactivation varicella-zoster virus (VZV) that causes chickenpox

Skin lesion is characterized by a pruritic, maculopapular, vesicular rash that evolves into noninfectious dried crusts over a 3- to 7-day period.

A typical history for herpes zoster might include neuropathic pain for around three days followed by a vesicular rash in a dermatomal distribution

Consider treatment with an antiviral for those over 50, or with evidence of trigeminal nerve involvement (ideally within 72 hours of symptoms), and refer those who are immunocompromised and/or have eye involvement

The rash takes around two weeks to resolve and can scar

Post-herpetic neuralgia is the most common complication and is more likely in older people, where it can take six months or more to resolve

Examples of vesicular rash caused by herpes zoster


  1. Le PRothberg MHerpes zoster infection doi:10.1136/bmj.k5095