Herpes Zoster (Shingles)

Your Path

  • Herpes Zoster (Shingles)


  • Dermatomal manifestation of prior chicken pox
  • Virus lives in dorsal root ganglion, reactivates for unknown reasons

Risk Factors

  • HIV+
  • Increasing age over 50
  • Otherwise immunocompromised
  • Lack of adult vaccination (to prevent Shingles)
  • Children can be vaccinated to prevent primary infection (presumably will decrease risk shingles)


  • Burning type pain in dermatomal region for 1-3 d prior to eruption
  • Then characteristic dermatomal skin eruption, with vesicles appearing over 3-5 days
  • Resolves over 2-4 weeks
  • Persistent neuropathic pain can last for months (risk increases with age)
  • If HIV + and low CD4, tends to persist and recur; also higher risk for more severe and disseminated disease
  • Ha, confusion, neck stiffness w/meningitis or encephalitis--> rare, typically limited to immunocompromised hosts
  • Ear pain, peripheral facial nerve palsey with Ramsay-Hunt from CN7 involvement; due to proximity w/CN8, may also have hearing loss, hyperacusis, tinnitus, vertigo

Physical Exam Findings

  • Vesicles, which appear in a 1-2 (adjacent) dermatomal distribution
  • Doesn't typically cross mid-line of the body
  • Can sometimes have bacterial supra-infection (cellulitis)
  • Infection in eye region (zoster ophthalmicus) presents risk to vision
  • Ramsay Hunt--> vessicles on ear drum/canal, face, CN7 palsy
  • Resolution of skin findings in 2-4w