ACUTE HERPES ZOSTER AND POSTHERPETIC NEURALGIA

Abstract

Herpes zoster (HZ) is a localized disease characterized by unilateral radicular pain and a vesicular cutaneous eruption that is generally limited to the dermatome innervated by a single spinal or cranial sensory ganglion. It results from reactivation of an endogenous varicella-zoster virus (VZV) infection that has persisted in latent form within the sensory ganglia following an earlier attack of varicella. 109,180,212 Pain is a major symptom of HZ. It often precedes and generally accompanies the characteristic rash, and it frequently persists after the rash has healed—a complication known as postherpetic neuralgia (PHN). Pain during the acute phase of HZ and PHN has a severe impact on quality of life and accounts for much of the morbidity of HZ. Many treatments have been employed to reduce the severity of HZ, prevent the development of PHN, and relieve the pain and suffering caused by the complication of PHN. Few have proven beneficial, however, and there is a dearth of well-designed and well-controlled studies evaluating treatment outcomes in HZ and PHN. This article reviews the natural history and pathogenesis of HZ and PHN and critically evaluates approaches to treatment and prevention. This discussion is limited to HZ and PHN in immunocompetent patients. The management of HZ and its complications in immunosuppressed patients is not addressed.