Herpes Zoster
Overview
The varicella zoster virus (VZV) is responsible for the occurrence of herpes zoster and chickenpox. Chickenpox results from the primary infection with the virus, and after recovery, the virus remains dormant in the body. It can reactivate later, manifesting as herpes zoster. Approximately 25% of healthy adults and 50% of immunocompromised individuals will experience herpes zoster at least once in their lifetime. The disease affects both men and women. The likelihood of recurrence is around 1-5%.
Causes
The appearance of herpes zoster is more likely to occur in cases where the immune system is weakened, such as:
- Individuals over 50 years old (the risk increases with age)
- Individuals who have undergone surgery (especially if they have been under general anesthesia)
- Severe stress or anxiety
- Following a serious injury (the recovery process may weaken the body)
- Individuals with a weakened immune system (due to immunosuppressive medications, chemotherapy, or radiation therapy)
- Certain medical conditions (such as diabetes, inflammatory bowel diseases)
Symptoms
Pre-Rash Symptoms
Symptoms before the appearance of the rash include:
- Localized pain (in some cases, the pain may be sharp)
- Burning sensations
- Itching
- Hypersensitivity in the area where the rash will develop
Systemic Symptoms
Some patients may experience:
- Fever
- Muscle aches
- Fatigue
- Headache
- Lymphadenitis
Rash Characteristics
The rash presents as papules that transform into blisters and then into pustules within 24 hours. Typically, the blisters crust over (form scabs) in 7-10 days and resolve within 2-3 weeks. The rash is localized to a specific area, on one side of the body or face, with a band-like distribution along a dermatome.
Complications
Herpes zoster typically resolves without complications. However, in about 10-15% of cases, the most common complication can occur, known as postherpetic neuralgia, which causes pain at the site of herpes zoster even after the rash has completely healed. These discomforts can last for months to years.
Other complications (depending on the part of the body) may include:
Ocular Complications
- Conjunctivitis
- Keratitis
- Optic neuritis
- Potential blindness
Auditory Complications
- Involvement of the eardrum
- Potential deafness
Rare Complications
- Meningitis
- Facial paralysis
- Generalized herpes zoster
Treatment
When treatment begins within 72 hours of symptom onset, it can lead to milder symptoms and shorter duration. Treatment includes:
Topical Treatment
- Topical antibiotics
- Antiseptics
- Compresses for relief
Systemic Treatment
Administration of antiviral medications:
- Acyclovir
- Valacyclovir
- Famciclovir
Pain Management
Analgesics given to control pain, which is often so intense that patients cannot tolerate even their clothing touching the affected area.
Vaccination
The inactivated recombinant vaccine (RZV) is administered intramuscularly in two doses:
- For individuals aged 18 and older with immunosuppression (including patients with HIV), with a recommended interval of 1-2 months
- For individuals aged 60 and older, with a recommended interval of 2 months (vaccination should be completed no later than 6 months from the first dose)
RZV is safe and effective when administered one year after a herpes zoster infection and 5 or more years after prior vaccination with ZVL.
Conclusion
Understanding and timely managing herpes zoster are crucial to avoid complications and to improve quality of life.