Herpes zoster

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: -

Shingles.

Contagious, segmentally arranged skin disease, which is caused by reactivation of VZV in the spinal and cranial nerve ganglia

Lifetime prevalence: 20%.

  • Incubation period: 1-2 weeks
  • Predisposing factors:
    • Immune suppression
    • Stress
    • Older age

Herpetiform, grouped, segmentally arranged blisters on an erythematous base. In the course of the disease, the blisters burst and crusts form. If there are no more blisters, the patient is no longer classified as infectious. In some cases, there is pain, allodynia, itching, reduced general condition and, rarely, fever.

  • Clinical appearance
  • Tzanck test: swab with cotton swab from the base of the vesicle (press firmly)
    • Smear onto a microscope slide, stain with methylene blue
  • PCR
    • Swab with cotton swab from base of bubble (press firmly). Place cotton swab in virus medium, leave for 15 sec, then remove swab

Unilateral on the body. Mostly thoracic dermatome, second most common in trigeminal area.

Rarely also other localisations, e.g. genital.

  • Postzoster neuralgia
  • CNS involvement of the zoster
  • Pyogenic infections
  • Herpetic keratitis in V.1 infestation

Shingrix vaccination recommended, Zostavax is far less effective.

Vaccination also recommended after clinical course of herpes zoster. Recurrences occur in 6% after zoster, of which approx. 50% occur at the same site.

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