Skin Disorders
Bookmark and Share
   Acquired Melanocytic Nevocellular Nevi
   Acral Lentiginous Melanoma
   Acute HIV Syndrome
   Acute Lymphangitis
   Acute Sun Damage
   Adult T Cell Leukemia
   Adverse Cutaneous Drug Reactions
   Alopecia Areata
   Androgenetic Alopecia
   Aphthous Ulcer
   Bacillary Angiomatosis
   Bacterial Infections
   Basal Cell Carcinoma
   Basal Cell Nevus Syndrome
   Behcet's Syndrome
   Benign Cutaneous Neoplasms
   Capillary Hemangioma of Infancy
   Cat-Scratch Disease
   Chronic Lupus Panniculitis
   Chronic Venous Insufficiency
   Clark Melanocytic Nevus
   Congenital Nevomelanocytic Nevus
   Crest Syndrome
   Cutaneous Candidiasis
   Cutaneous Larva Migrans
   Cutaneous Lupus Erythematosus
   Cutaneous and Mucocutaneous Leishmaniasis
   Cutaneous Pseudomonas Aeruginosa Infections
   Cutaneous Reactions to Arthropod Bites
   Cutaneous T Cell Lymphoma
   Desmoplastic Melanoma
   Disseminated Coccidioidomycosis
   Disseminated Cryptococcosis
   Disseminated Gonococcal Infection
   Disseminated Intravascular Coagulation
   Drug Hypersensitivity Syndrome
   Drug-Induced Acute Urticaria
   Drug-Induced Pigmentation
   Eosinophilic Folliculitis
   Erysipelas and Cellulitis
   Erythema Infectiosum
   Erythropoietic Protoporphyria
   Exanthematous Drug Reactions
   Exfoliative Erythroderma Syndrome
   Extramammary Paget's Disease
   Eye Stye
   Fixed Drug Eruption
   Gangrenous Cellulitis
   Genital Candidiasis
   Giant Cell Arteritis
   Glucagonoma Syndrome
   Graft Versus Host Disease
   Hand-Foot-and-Mouth Disease
   Herpes Gestationis
   Herpes Simplex Virus: Genital Infections
   Herpes Simplex Virus Infection
   Herpes Simplex Virus: Infections Associated Systemic Immunocompromise
   Herpes Simplex Virus
   Herpes Zoster
   HIV Associated Lipodystrophy Syndrome
   Human Papillomavirus: Mucosal Infections
   Human Papillomavirus: Squamous Cell Carcinoma In Situ
   Human Papillomavirus
   Hypersensitivity Vasculitis
   Hypertrophic Scars and Keloid
   Impetigo and Ecthyma
   Infectious Exanthems
   Infectious Folliculitis
   Infective Endocarditis
   Infestations of the Skin
   Kaposi's Sarcoma
   Kawasaki's Disease

Home :: Herpes Zoster

Herpes Zoster

Herpes zoster (HZ) is an acute dermatomal infection associated with reactivation of varicella-zoster (VZV) and is characterized by unilateral pain and a vesicular or bullous eruption limited to a dermatome(s) innervated by a corresponding sensory ganglion. The major morbidity is postherpetic neuralgia (PHN).

Causes of Herpes Zoster

Most physicians believe there is a temporary weakness in the body's ability to fight off disease. This allows the virus to start reproducing and move along nerve fibers toward the skin. The fact that the disease occurs more often in people older than age 50 (although children can get it, too) supports this since the immune response is believed to be weaker in older people. Trauma or possibly stress may also trigger a zoster attack.

Symptoms of Herpes Zoster

Symptoms may include:

  • skin hypersensitivity in the area where the herpes zoster appears
  • mild rash, which appears after five days and first looks like small, red spots that turn into blisters
  • blisters which turn yellow and dry
  • rash which usually goes away in one to two weeks
  • rash is usually localized to one side of the body


Prodromal Stage Suspect HZ in older or immunocompromised individual with unilateral pain.

Active Vesiculation Clinical findings usually adequate; may be confirmed by Tzanck test and possible DFA or viral culture to rule out HSV infection.

PHN By history and clinical findings.


Goals of management Relieve constitutional symptoms; minimize pain; reduce viral shedding; prevent secondary bacterial infection; speed crusting of lesions and healing; ease physical, psychological, emotional discomfort; prevent viral dissemination or other complications; prevent or minimize PHN.

Antiviral therapy In individuals at high risk for reactivation of VZV infection, oral acyclovir can reduce the incidence of HZ. In prodromal stage: begin antiviral agent if diagnosis is considered likely; analgesics. With active vesiculation: antiviral therapy begun ≤72 h accelerates healing of skin lesions, decreases the duration of acute pain, and may decrease the frequency of PHN when given in adequate dosage.

  • Acyclovir 800 mg PO qid for 7-10 days. The 50% viral inhibitory concentration of acyclovir is three to six times higher for VZV than for HSV in vitro, and drug dose must be increased appropriately. The bioavailability of acyclovir is only 15 to 30% of the orally administered dose. For ophthalmic zoster and HZ in the immuno compromised host, acyclovir should be given intravenously. Acyclovir hastens healing and lessens acute pain if given within 48 h of the onset of the rash.
  • Valacyclovir 1000 mg PO tid for 7 days, 70 to 80% bioavailable.

Supportive therapy for acute HZ

  • Constitutional symptoms Bed rest, NSAIDs.
  • Sedation Pain often interferes with sleep. Sleep deprivation and pain commonly result in depression. Doxepin, 10 to 100 mg hs, is an effective agent.

Chronic stages (PHN) Pain is that of reflex sympathetic dystrophy.

  • Pain management Severe prodromal pain or severe pain on the first day of rash is predictive of severe PHN. Gabapentin: 300 mg tid. Tricyclic antidepressants such as doxepin, 10 to 100 mg PO hs. Capsaicin cream every 4 h. Topical anesthetic such as EMLA or 5% lidocaine patch for allodynia. Nerve block to area of allodynia. Analgesics.
  • Immunization Immunization with VZV vaccine may boost humoral and cell-mediated immunity and decrease the incidence of zoster in populations with declining VZV-specific immunity.
More Skin Disorders
   Langerhans Cell Histiocytosis
   Leg Ulcers
   Lentigo Maligna
   Leukemia Cutis
   Livedo Reticularis
   Localized Infection
   Lupus Erythematosus
   Lyme Borreliosis
   Lymphogranuloma Venereum
   Lymphomatoid Papulosis
   Malignant Melanoma of the Mucosa
   Mammary Paget's Disease
   Mastocytosis Syndromes
   Merkel Cell Carcinoma
   Metastatic Cancer to the Skin
   Molluscum Contagiosum
   Mycobacterium Fortuitum Complex Infection
   Mycobacterium Marinum Infection
   Mycobacterium Ulcerans Infection
   Necrobiosis Lipoidica
   Neisseria Gonorrhoeae Infections
   Nodular Melanoma
   Nodular Vasculitis
   Nongenital Herpes Simplex Virus Infection
   North American Blastomycosis
   Oral Hairy Leukoplakia
   Oropharyngeal Candidiasis
   Other Viral Infections
   Papulosquamous Conditions
   Pediculosis Capitis
   Pediculosis Pubis
   Photoallergic Drug Induced Photosensitivity
   Phototoxic Drug Induced Photosensitivity
   Pitted Keratolysis
   Pityriasis Versicolor
   Polyarteritis Nodosa
   Polymorphous Light Eruption
   Porphyria Cutanea Tarda
   Port-Wine Stain
   Premalignant and Malignant Skin Tumors
   Pressure Ulcers
   Pruritic Urticarial Papules
   Pseudoxanthoma Elasticum
   Pyogenic Granuloma
   Radiation Dermatitis
   Raynaud's Disease
   Reiter's Syndrome
   Rocky Mountain Spotted Fevers
   X-Linked Hyper-IgM Syndrome
   Xeroderma Pigmentosum
   Yellow Fever
   Yellow Nail Syndrome
   Zinc Deficiency

Skin Disorders || Contact Us || Tweet

Copyright © All Rights Reserved.

Disclaimer - The data contained in the Web pages is provided for the purpose of educational purposes and information only. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician - patient relationship. We are not responsible for any consequence resulted from using this information. Please always consult your physician for medical advices and treatment.