Abstract
Herpes zoster or Shingles is caused by varicella-zoster virus (VZV), the same virus that causes chicken-pox (varicella).Primary infection with varicella-zoster virus causes chicken-pox (varicella), then the virus persists in nerve ganglia of sensory but rarely motor nerves, in a latent stage.If the virus gets reactivated it causes herpes zoster, which presents as painful vesicles following a dermatome. It is more common in the elderly and the immunocompromised.Herpes zoster is a common skin and mucous membrane disease caused by reactivation of latent varicella zoster virus, which had lodged previously in nerve ganglia.Trigeminal nerve nuclei and thoracic spinal ganglia are the most commonly affected.Reactivation of latent varicella-zoster virus can be triggered by old age, that is why herpes zoster is common in the elderly, above 60 years of age. This is due to age related decline in specific cell mediated immune response to VZV. Other triggering factors are malignancies malnutrition, emotional stress, physical trauma, chronic diseases like diabetes mellitus and immunosuppression from drugs and HIV.¹,²
Highlights
Herpes zoster typically presents with pain followed by erythema and eruption of vesicles on the affected dermatome
If the trigeminal nerve is involved, differentiating zoster sine herpete (ZSH) from idiopathic trigeminal neuralgia can be difficult, but clinical history can be helpful as the pain of ZSH is more continuous like postherpetic neuralgia rather than the intermittent pain of idiopathic trigeminal neuralgia.[6]
This is herpes zoster involving the ophthalmic division of trigeminal nerve, the fifth cranial nerve ( Figure 3)
Summary
Herpes zoster typically presents with pain followed by erythema and eruption of vesicles on the affected dermatome. The pain of herpes zoster is variously described as sharp, stabbing, shooting, burning, throbbing or tender.[1,3]. VZV can reactivate and cause pain without eruption of vesicles. This is referred to as zoster sine herpete (ZSH) or zoster sine eruptione.[4,5]. The time between the start of pain and the onset of the eruption is about one and a half days in trigeminal zoster and about three days in thoracic disease.[4]. Herpes zoster usually occurs only once in an individual’s lifetime, but recurrences are frequent in the immunocompromised.[1]
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