Herpes Zoster (Shingles) Questions & Answers

Updated: Jan 25, 2019
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Questions & Answers

Overview

What is herpes zoster (shingles)?

What are the 3 phases of herpes zoster (shingles)?

How is the preeruptive phase of herpes zoster (shingles) characterized?

How is the acute eruptive phase of herpes zoster (shingles) characterized?

How is the postherpetic neuralgia (PHN) of herpes zoster (shingles) characterized?

What are the signs and symptoms of herpes zoster (shingles) ophthalmicus (HZO)?

What are the forms of herpes zoster?

How is herpes zoster (shingles) diagnosed?

Which lab studies are used to detect varicella-zoster virus (VZV)?

How severe is herpes zoster in children?

What are conservative therapy options for herpes zoster (shingles)?

What are some primary medications for acute zoster-associated pain?

What is the role of steroids in the treatment of herpes zoster (shingles)?

What is the role of antiviral therapy in the treatment of herpes zoster (shingles)?

Which oral medications are used to treat herpes zoster (shingles)?

When is hospital admission indicated for the treatment of herpes zoster (shingles)?

What are the treatment options for postherpetic neuralgia (PHN) of herpes zoster (shingles)?

What is the efficacy of vaccination against herpes zoster (shingles)?

What is herpes zoster (shingles)?

What are risk factors for herpes zoster (shingles)?

What is the role of cellular immune response in the pathogenesis of herpes zoster (shingles)?

How severe is herpes zoster (shingles)?

Which 2 syndromes arise from varicella-zoster virus (VZV) infection?

What is the pathophysiology of varicella-zoster virus (VZV) reactivation?

What is the pathophysiology of cutaneous rash in herpes zoster (shingles)?

How contagious are herpes zoster (shingles) infections?

What is the central nervous system (CNS) involvement in the pathogenesis of herpes zoster (shingles)?

What is the optical system involvement in herpes zoster (shingles)?

What is the auditory system involvement in herpes zoster (shingles)?

What are the clinical phases of herpes zoster (shingles)?

What is the signs and symptoms of the preeruptive phase of herpes zoster (shingles)?

What are the signs and symptoms of the acute eruptive phase of herpes zoster (shingles)?

What is postherpetic neuralgia (PHN) of herpes zoster (shingles)?

What causes herpes zoster (shingles)?

What are triggers for VZV reactivation?

What role does the dorsal root ganglion play in the etiology of herpes zoster (shingles)?

What are comorbidities of herpes zoster (shingles)?

What causes postherpetic neuralgia (PHN) of herpes zoster (shingles)?

What are the risk factors in children and adults for the development of herpes zoster (shingles)?

What is immune reconstitution inflammatory syndrome (IRIS) in herpes zoster (shingles)?

What are the signs and symptoms of immune reconstitution inflammatory syndrome (IRIS) in herpes zoster (shingles)?

What are the associations between inflammatory bowel disease (IBD) and herpes zoster (shingles)?

Which malignancies are predisposing factors for herpes zoster (shingles)?

Which medical conditions increase the risk of herpes zoster (shingles)?

Why is age considered a risk factor for herpes zoster (shingles)?

What is the frequency of recurrent herpes zoster (shingles)?

What is the frequency of herpes zoster ophthalmicus (HZO?

What is the prevalence of herpes zoster (shingles) in the US?

What is the global incidence of herpes zoster (shingles)?

How does the incidence of herpes zoster (shingles) vary among age groups?

How does the incidence of herpes zoster (shingles) vary between males and females?

How does the incidence of herpes zoster (shingles) vary among races and ethnicities?

What is the prognosis of herpes zoster (shingles)?

What is the mortality rate for herpes zoster (shingles)?

What is the morbidity of herpes zoster (shingles)?

How is the prognosis of herpes zoster (shingles) affected by presentation?

Which are health risks increased with herpes zoster (shingles)?

What information about herpes zoster (shingles) should patients receive?

Presentation

What are the nonspecific early symptoms of herpes zoster (shingles)?

What are the signs and symptoms of herpes zoster (shingles)?

What are the symptoms of herpes zoster (shingles) following the prodromal phase?

Who is at highest risk for postherpetic neuralgia (PHN) in herpes zoster (shingles)?

What are less common postherpetic sequelae of herpes zoster (shingles)?

What is herpes zoster oticus (Ramsay Hunt syndrome)?

What are physical findings characteristic of herpes zoster (shingles)?

What is presented in a patient with herpes zoster (shingles) after a prodromal illness?

What are possible clinical variations of herpes zoster (shingles)?

What is herpes zoster (shingles) ophthalmicus (HZO)?

What are the prodromal symptoms of herpes zoster ophthalmicus (HZO)?

What are central nervous system (CNS) findings suggestive of in herpes zoster (shingles)?

What are the symptoms of herpes zoster (shingles) ophthalmicus (HZO)?

How is the eye involved in the herpes zoster ophthalmicus (HZO)?

What is the prevalence of postherpetic neuralgia (PHN) herpes zoster (shingles) ophthalmicus (HZO)?

What other complications can arise in herpes zoster ophthalmicus (HZO)?

Which physical findings are characteristic of herpes zoster of maxillary branch of cranial nerve (CN) V?

Which physical findings are characteristic of herpes zoster of mandibular branch of cranial nerve (CN) V?

What is herpes zoster oticus?

Which physical findings suggest glossopharyngeal zoster (herpes pharyngis) and vagal zoster (herpes laryngis)?

Which physical findings suggest herpes occipiticollaris?

Which physical findings suggest herpes zoster encephalomyelitis?

What is herpes zoster myelitis and how does it present?

What is disseminated herpes zoster (shingles)?

What is suggested by a finding of herpes zoster involving multiple dermatomes?

What is bilateral herpes zoster?

What is characteristic of recurrent herpes zoster (shingles)?

Which physical findings suggest herpes zoster (shingles) involving the urinary bladder?

Which physical findings suggest vesicular involvement in herpes zoster (shingles)?

Which physical findings suggest motor complications of herpes zoster (shingles)?

What is herpes zoster sine herpete?

How is Guillain-Barré syndrome associated with herpes zoster (shingles)?

What is the risk of fatality in patients with herpes zoster (shingles)?

What is the most common complication of herpes zoster (shingles)?

What are complications of herpes zoster ophthalmicus (HZO)?

What are complications of herpes zoster oticus (Ramsay Hunt syndrome)?

Which secondary bilateral infections are associated with herpes zoster (shingles)?

What are central nervous system (CNS) complications of herpes zoster (shingles)?

What group is at risk for disseminated herpes zoster (shingles)?

Have GI complications of herpes zoster (shingles) been reported?

What are complications of herpes zoster in children?

DDX

How is herpes simplex virus (HSV) differentiated from herpes zoster (shingles)?

How are central nervous system (CNS) complications of herpes zoster (shingles) differentiated from other forms of meningoencephalitis?

Which conditions should be included in the differential diagnoses of herpes zoster (shingles)?

What are the differential diagnoses for Herpes Zoster (Shingles)?

Workup

How is herpes zoster (shingles) diagnosed?

What is the role of lab testing in the diagnosis of herpes zoster (shingles)?

What is the incidence of malignancy in patients with herpes zoster (shingles)?

What is the role of Tzanck smear in the workup of herpes zoster (shingles)?

Which tests are performed to confirm the diagnosis of herpes zoster (shingles)?

Which is the role of PCR assay testing in the diagnosis of herpes zoster (shingles)?

Why should an HIV test be performed in patients with herpes zoster (shingles)?

What is the role of imaging studies in the diagnosis of herpes zoster (shingles)?

Which histological findings are characteristic of herpes zoster (shingles)?

What is the histologic finding of lymphocytes in herpes zoster (shingles)?

What is the role of conventional microscopy in the diagnosis of herpes zoster (shingles)?

Treatment

What are the treatment options for herpes zoster (shingles)?

Which patient groups benefit the most from treatment of herpes zoster (shingles)?

When is hospital admission indicated for treatment of herpes zoster (shingles)?

When is transfer to higher levels of care indicated for herpes zoster (shingles)?

Which medications used to treat herpes zoster (shingles)?

What is the role of Varicella-zoster immune globulin (VZIG) in the management of herpes zoster (shingles)?

What are the topical treatment options for herpes zoster (shingles)?

What are the goals of therapy for herpes zoster (shingles)?

What is the role of corticosteroids in the treatment of herpes zoster (shingles)?

What is the corticosteroids dose regimen for treating herpes zoster (shingles)?

What is the role of combination therapy for the treatment of herpes zoster (shingles)?

Are combinations therapies effective treatments for herpes zoster (shingles)?

Why should corticosteroids use for the treatment of herpes zoster (shingles) be limited?

What is the duration of steroid therapy for herpes zoster (shingles)?

What are the options for pain management of herpes zoster (shingles)?

Which therapies are effective in reducing acute pain in herpes zoster (shingles)?

What is the efficacy of antiviral agents in treating herpes zoster (shingles)?

What is the role of antiviral agents in the treatment of herpes zoster (shingles)?

What is the duration of antiviral treatment for herpes zoster (shingles)?

What are the limitations of antivirals to treat herpes zoster (shingles)?

What are concerns for immunocompromised patients with herpes zoster (shingles)?

What therapy is recommended for immunocompromised patients with herpes zoster (shingles)?

What is the role of IV acyclovir in the treatment of herpes zoster (shingles)?

What is the role of oral antiviral agents in the treatment of herpes zoster (shingles)?

What is the role of antiviral therapy in the treatment of herpes zoster ophthalmicus?

When should postherpetic neuralgia (PHN) be suspected in herpes zoster (shingles)?

How is the pain of acute herpes zoster (shingles) differentiated from that of postherpetic neuralgia (PHN)?

How is postherpetic neuralgia (PHN) prevented?

What are treatment options for postherpetic neuralgia (PHN) of herpes zoster?

What is the role of gabapentin in the treatment of postherpetic neuralgia (PHN)?

Which topical agents are used in the treatment of postherpetic neuralgia (PHN)?

What is the role of combination therapies in the treatment of postherpetic neuralgia (PHN)?

What is the Pavan-Langston proposed protocol for treatment of chronic phase postherpetic neuralgia (PHN)?

What is the role of anesthesia-based treatment of postherpetic neuralgia (PHN)?

What dietary modifications are included in the management of herpes zoster (shingles)?

What are the activity restrictions during treatment for herpes zoster (shingles)?

When should isolation measures be taken in the treatment of herpes zoster (shingles)?

What is the rationale for vaccination against VZV?

What is the efficacy of varicella-zoster virus (VZV) vaccine (Varivax) in the preventions of herpes zoster (shingles)?

What is the efficacy of varicella-zoster virus (VZV) vaccine (Varivax) in preventing herpes zoster (shingles) in the elderly?

What are the 2018 CDC adult immunization schedules regarding herpes zoster?

Who does the CDC recommend receive varicella-zoster virus (VZV) vaccine (Varivax) for prevention of herpes zoster (shingles)?

When is vaccination indicated for the prevention of herpes zoster (shingles)?

What is the safety and efficacy of the zoster vaccine in the prevention herpes zoster (shingles)?

When is the Zostavax vaccine indicated for the prevention of herpes zoster (shingles)?

When is the Zostavax vaccine contraindicated for the prevention of herpes zoster (shingles)?

How long does the Zostavax vaccine remain effective for the prevention of herpes zoster (shingles)?

What is the efficacy of the Shingrix vaccine in the prevention of herpes zoster (shingles)?

Other than vaccines, how can herpes zoster (shingles) be prevented?

What is the role of varicella-zoster immune globulin (VZIG) in the prevention of herpes zoster (shingles)?

What specialist consultations are needed for the management of herpes zoster (shingles)?

What long-term monitoring is needed following treatment of herpes zoster (shingles)?

Guidelines

Which organizations have issued treatment guidelines for herpes zoster (shingles) and its complications?

What are the IASP recommendations for the treatment of herpes zoster (shingles)?

What are the IASP recommendations for the treatment of herpes zoster (shingles) in immunocompromised patients?

What are the AAFP recommendations for the treatment of herpes zoster (shingles)?

What are the IDSA recommendations for the management of herpes zoster (shingles) in immunocompromised patients?

What are the IASP recommendations for the management of herpes zoster ophthalmicus (HZO)?

What are the AAN recommendations for the treatment of postherpetic neuralgia (PHN)?

What are the CDC recommendations for routine vaccination against herpes zoster (shingles)?

What are the CDC recommendations for the prevention of herpes zoster (shingles)?

What are the IDSA vaccination recommendations for the prevention of herpes zoster (shingles)?

Medications

Which medications in the drug class Antidepressants, TCAs are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Anticonvulsants are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Analgesics are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Anesthetics, Topical are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Analgesics, Topical are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Vaccines, Live, Viral are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Vaccines, Inactivated, Viral are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Corticosteroids are used in the treatment of Herpes Zoster (Shingles)?

Which medications in the drug class Antivirals are used in the treatment of Herpes Zoster (Shingles)?