Comprehensive review and update on herpes zoster

Abstract

Herpes zoster (HZ) is the result of reactivation and multiplication of latent varicella zoster virus that persisted in latent form within the sensory ganglia following an earlier attack of varicella. It occurs most frequently in older adults and immunosuppressed individuals. Classically, the rash presents as painful, erythematous, maculopapular, and vesicular lesions that typically involve single dermatome, and usually do not cross the midline. The diagnosis is mainly made clinically, except in patients with atypical manifestations in which laboratory virologic testing is required. HZ has been associated with several complications, of which postherpetic neuralgia is the most common and debilitating. The treatment of HZ includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. The options for treating postherpetic neuralgia include lidocaine patch, high dose capsaicin patch, gabapentin, pregabalin, opioids, and tricyclic antidepressants. A live attenuated zoster vaccine reduces the incidence of by one-half and the incidence of postherpetic neuralgia by two-thirds. We herein review the recent data on the epidemiology, pathophysiology, diagnosis and management of HZ including HZ vaccine.