eMedicine Specialties > Infectious Diseases > Viral Infections

Herpes Zoster: Follow-up

Author: James E Moon, MD, Clinical Investigator, Department of Clinical Trials, Walter Reed Army Institute of Research and Assistant Professor, Department of Medicine, Uniformed Service University of Health Sciences
Coauthor(s): Duane R Hospenthal, MD, PhD, Chief, Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center; Professor of Medicine, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Nov 23, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is recommended for any patient at risk for dissemination or for those requiring IV medications, as well as any patient demonstrating disseminated disease or ophthalmic or meningoencephalopathic involvement.

Further Outpatient Care

  • Follow up until symptoms resolve.
  • Inform patients about the natural progression of herpes zoster and its potential complications.
  • Pain relief should be a primary concern.
  • Patients who develop postherpetic neuralgia should be seen regularly and should receive emotional support in addition to medical therapy.

Transfer

  • Patients with disseminated disease, severe immunosuppression, or those unresponsive to therapy should be transferred to a higher level of care.
  • If consultation is required but not available at the initial facility, patients should be transferred to a tertiary care medical center.

Deterrence/Prevention

The Advisory Committee on Immunization Practices (ACIP) recently issued updated adult vaccination scheduling guidelines for October 2007 through September 2008. These guidelines include changes for varicella and zoster vaccines.8

Prognosis

  • The prognosis for younger and otherwise healthy patients is excellent.
  • Elderly people have a significantly increased risk of complications, including postherpetic neuralgia, bacterial infections, and scarring.

Patient Education

  • During the acute phase, patients are infective to others and should be instructed to avoid contact with elderly people, people who are immunocompromised, pregnant women, or people with no history of chickenpox infection.
  • Patients should be instructed to not scratch the lesions, which may predispose them to secondary bacterial infections.
  • For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Shingles and Chickenpox.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis or failure to treat patients with involvement of the trigeminal nerve may lead to long-term ophthalmic complications.
  • Take special care with immunocompromised and debilitated patients. Err on the side of admitting immunosuppressed patients and those with eye or symptomatic CNS involvement.
 
Acknowledgments

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting true views of the Department of the Army or the Department of Defense.



More on Herpes Zoster

Overview: Herpes Zoster
Differential Diagnoses & Workup: Herpes Zoster
Treatment & Medication: Herpes Zoster
Follow-up: Herpes Zoster
Multimedia: Herpes Zoster
References
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References

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Further Reading

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Keywords

herpes zoster, shingles, HZ, varicella-zoster virus, VZV, preherpetic neuralgia, postherpetic neuralgia, PHN, varicella, chickenpox, herpes zoster ophthalmicus, HZO, Ramsay-Hunt syndrome, herpes zoster oticus, geniculate neuralgia, herpes zoster auricularis

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Contributor Information and Disclosures

Author

James E Moon, MD, Clinical Investigator, Department of Clinical Trials, Walter Reed Army Institute of Research and Assistant Professor, Department of Medicine, Uniformed Service University of Health Sciences
Disclosure: Nothing to disclose.

Coauthor(s)

Duane R Hospenthal, MD, PhD, Chief, Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center; Professor of Medicine, Uniformed Services University of the Health Sciences
Duane R Hospenthal, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Society for Infectious Diseases, International Society of Travel Medicine, and Medical Mycology Society of the Americas
Disclosure: Nothing to disclose.

Medical Editor

Mark R Wallace, MD, FACP, FIDSA, Clinical Professor of Medicine, Florida State University College of Medicine; Infectious Disease Fellowship Director, Orlando Regional Medical Center
Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gordon L Woods, MD, Consulting Staff, Department of Internal Medicine, University Medical Center
Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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