eMedicine Specialties > Emergency Medicine > Infectious Diseases

Herpes Zoster: Follow-up

Author: Richard S Krause, MD, Senior Faculty, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Contributor Information and Disclosures

Updated: Jun 1, 2009

Follow-up

Deterrence/Prevention

  • Theoretically, current varicella vaccines will reduce zoster incidence.
  • Vaccines are being tested for prevention of herpes zoster in individuals previously infected with wild varicella-zoster virus.
  • Patients with zoster may transmit the virus, causing infections in susceptible persons (who have not had prior infection).
    • Discharge instructions should include patient education to avoid contact with susceptible individuals, especially if they are pregnant (due to concerns about congenital varicella) or immunocompromised.
    • Transmission is by direct contact, and lesions are considered infectious until they are all crusted over.

Complications

Complications of herpes zoster may include the following:

Prognosis

  • Rash usually resolves within 14-21 days.
  • Postherpetic neuralgia is defined as pain persisting at least 1 month after the rash has healed. Its incidence increases dramatically with age (ie, 4% in those aged 30-50 years, 50% in those older than 80 years).

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize involvement of the nasociliary nerve as demonstrated by lesions on the tip of the nose; therefore, failure to perform a slit-lamp examination with fluorescein stain to identify the dendritic corneal lesions of herpetic keratitis
  • Failure to administer antiviral therapy to those who are immunocompromised
  • Administration of steroids without concomitant antiviral therapy
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Chris D Melton, MD, to the development and writing of this article.



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

  1. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. Aug 1995;155(15):1605-9. [Medline].

  2. [Best Evidence] Dworkin RH, Barbano RL, Tyring SK, Betts RF, McDermott MP, Pennella-Vaughan J, et al. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Pain. Apr 2009;142(3):209-17. [Medline].

  3. [Best Evidence] Irving G, Jensen M, Cramer M, Wu J, Chiang YK, Tark M, et al. Efficacy and tolerability of gastric-retentive gabapentin for the treatment of postherpetic neuralgia: results of a double-blind, randomized, placebo-controlled clinical trial. Clin J Pain. Mar-Apr 2009;25(3):185-92. [Medline].

  4. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. Jan 1 2007;44 Suppl 1:S1-26. [Medline].

  5. Beutner KR, Friedman DJ, Forszpaniak C, Andersen PL, Wood MJ. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother. Jul 1995;39(7):1546-53. [Medline].

  6. Colin J, Prisant O, Cochener B, Lescale O, Rolland B, Hoang-Xuan T. Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster ophthalmicus. Ophthalmology. Aug 2000;107(8):1507-11. [Medline].

  7. Whitley RJ, Weiss H, Gnann JW Jr, Tyring S, Mertz GJ, Pappas PG, et al. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. Sep 1 1996;125(5):376-83. [Medline].

  8. Tyring S, Engst R, Corriveau C, Robillard N, Trottier S, Van Slycken S, et al. Famciclovir for ophthalmic zoster: a randomised aciclovir controlled study. Br J Ophthalmol. May 2001;85(5):576-81. [Medline].

  9. National Center for Immunization and Respiratory Diseases. Varicella Vaccine - Q&A about High Risk. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vaccines/vpd-vac/varicella/vac-faqs-clinic-highrisk.htm. Accessed December 11, 2008.

  10. Brody MB, Moyer D. Varicella-zoster virus infection. The complex prevention-treatment picture. Postgrad Med. Jul 1997;102(1):187-90, 192-4. [Medline].

  11. Kost RG, Straus SE. Postherpetic neuralgia--pathogenesis, treatment, and prevention. N Engl J Med. Jul 4 1996;335(1):32-42. [Medline].

  12. Nikkels AF, Pierard GE. Recognition and treatment of shingles. Drugs. Oct 1994;48(4):528-48. [Medline].

  13. Straus SE. Overview: the biology of varicella-zoster virus infection. Ann Neurol. 1994;35 Suppl:S4-8. [Medline].

  14. Wareham DW, Breuer J. Herpes zoster. BMJ. June 2007;334(7605):1211-1215. [Medline].

  15. Wood MJ. Current experience with antiviral therapy for acute herpes zoster. Ann Neurol. 1994;35 Suppl:S65-8. [Medline].

  16. Wood MJ, Johnson RW, McKendrick MW, Taylor J, Mandal BK, Crooks J. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. Mar 31 1994;330(13):896-900. [Medline].

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Further Reading

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Keywords

herpes zoster, shingles, zona ignea, zona serpiginosa, zoster, herpesvirus, varicella-zoster virus, VZV, VZV infection, VZV reactivation, varicella-zoster virus infection, zoster sine herpete, chickenpox, chicken pox, vesicular rash, zoster keratitis, Ramsay Hunt syndrome, herpeszosteroticus, transitory unilateral facial paralysis, postherpetic neuralgia, conjunctivitis, keratitis, corneal ulceration, iridocyclitis, glaucoma, peripheral facial nerve weakness, peripheral facial nerve palsy, myelitis, cranial nerve palsies, granulomatous angiitis, disseminated zoster, encephalitis, hepatitis, pneumonitis, tingling, burning, trigeminal neuralgia, herniated nucleus pulposus with radiculopathy, erythematous rash, meningoencephalitis, dorsal root ganglion

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Contributor Information and Disclosures

Author

Richard S Krause, MD, Senior Faculty, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Glenn Bowman, MD, MS, Consulting Staff, Highfield MRI, Columbus, Ohio
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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