Herpes zoster (HZ), also called shingles, is the result of re-activation of the varicella-zoster virus (HSV) for unknown reasons. HSV, which has remained in the nerve endings from the time of childhood chickenpox, emerges many years later.
Clinically, there are clusters of vesicles on a red base that evolve into crusted areas. The infection follows the nerve distribution so it is usually on one side of the body. The infection often begins as non-descript itching and burning, evolving into painful red areas, before the characteristic lesions appear. The lesions, because they follow the nerve endings, appears in clusters in a linear pattern. While the lesions of zoster often clear within two to four weeks, the excruciating pain that sometimes develop may last many months, particularly in older patients.
If HZ is recognized within the first few days of onset, oral antivirals will diminish the duration and intensity of pain. Once the disease is established, topical capsaicin can reduce the pain, provided it is applied at least four times a day. Rarely, does HZ recur, but it sometimes can cause scarring.
Sarah Brenner, MD