Varicella zoster virus (VZV) causes the common childhood infection called chickenpox. It also causes herpes zoster.

Herpes zoster (shingles)

‘Shingles’ results from a reactivation of the VZV. It may be preceded by a prodromal phase of tingling or pain, which is then followed by a painful and tender blistering eruption in a dermatomal distribution. The blisters occur in crops, may become pustular and then crust over. The rash lasts 2-4 weeks and is usually more severe in the elderly. Occasionally more than one dermatome is involved.
Complications of shingles include severe, persistent pain (post-herpetic neuralgia), ocular disease (if ophthalmic nerve involved) and rarely motor neuropathy.

Treatment

Herpes zoster requires adequate analgesia and antibiotics (if secondary bacterial infection is present). Valaciclovir 1 g or famciclovir 500 mg three times daily for 7 days is used, or oral aciclovir 800 mg, five times daily for 7 days helps shorten the attack if given early in the illness. High-dose intravenous aciclovir is needed for immunosuppressed patients. It remains unclear how useful aciclovir therapy is in preventing prolonged post-herpetic neuralgia.

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