Herpes zoster Pathogenesis Stages and Treatment Options

Herpes Zoster

Herpes Zoster

Herpes Zoster, Shingles and Zona are three medical terms used to describe one condition caused by Varicella Zoster virus (VZV). It is a viral infection that usually develops after initial chickenpox illness that mainly affects children, because VZV remains dormant in the nerve cell bodies and non neuronal satellite cells of the infected person (virus latency).

Shingles is characterized by painful skin rash that usually appears as a stripe of blisters (a belt like pattern) on one side of the body.


Varicella zoster virus breaks out of the nerve cell bodies and travels down nerve axons to cause viral infection of the skin in the region of the neuron.

What are the symptoms of shingles?

What are the early symptoms of shingles?

Prodromal stage

  1. Headache
  2. Fever
  3. Malaise
  4. Sensation of burning pain
  5. Itching
  6. Tingling numbness
  7. Paresthesia (pins and needles) is a medical term used to describe a condition characterized by an abnormal sensation such as burning or prickling that is usually felt in the hands, arms, legs, or feet, etc.
  8. Hyperesthesia (oversensitivity to environmental stimuli) is a medical term used to describe a condition characterized by an abnormal increase in sensitivity to sense stimuli (excessive physical sensitivity of the skin).

This stage occurs before the rash appears,  it is characterized by the symptoms mentioned above; however, it is often painless in children.

What are the late symptoms of shingles?

Active stage

1st phase:

  1. Pain and malaise
  2. Rash, rashes often appear on torso after 2-21 days from clinical onset (after the initial phase)

2nd phase:

  1. Fever and malaise continue
  2. Vesicular rash (small blisters filled with serous exudate), is a medical term used to describe a condition when a rash appears in the same place as multiple vesicles
  3. Painful vesicles become cloudy as they fill with blood. The vesicles usually crust over in a period of 7-10 days

Postherpetic neuralgia

It is a life long condition that affects nerve fibers and skin at the site previously affected by shingles causing persistent burning pain after the rash and blisters of shingles disappear.

Types of Shingles

Many types of herpes zoster infection are known, of them:

  1. Herpes Zoster Ophtalmicus – involves the orbit of the eye (trigeminal nerve) and causes a collection of eye problems such as conjuctivites, keratitis, uveitis, and optic nerve palsy that may lead to loss of vision.
  2. Herpes Zoster Oticus or Ramsay Hunt syndrome type 2, is a complication of shingles that is caused by the reactivation of varicella zoster virus in the geniculate, this condition involves the ear between the facial, vestibular and cochlear nerve bundles, and may lead into vertigo and hearing loss.

Shingles Precautions | Preventing VZV

How to prevent shingles?

Vaccination (vaccine: zostavax)

Treatment Options for Herpes Zoster

What topical medication is used for shingles?

Morphine or Xylocaine patch, Apply lidocaine plasters to affected area every 4 to 12 hours as needed to control pain.

Capsaicin cream (ZostrixTM),  Apply to affected area 3-5 times daily (Topical Route).

Rash heals in a period of 2 to 4 weeks, but residual nerve pain persists for months (Postherpetic Neuralgia) after the rash and blisters of shingles disappear.

Oral treatment of Herpes Zoster

What antiviral medication is used for shingles and how long does shingles last with acyclovir?

Acyclovir (Zovirax) is the drug of choice used to treat infections caused by the Varicella Zoster virus including cold sores, genital herpes, shingles and chickenpox. The optimal dose of valacyclovir (Valtrex) to treat shingles is 1000 mg three times a day until the rash has completely crusted over.

To increase treatment effectiveness, valacyclovir should be used within 48 to 72 hours after the first symptoms appear.




Herpes Zoster

Verified by: Dr.Diab (November 1, 2017)

Citation: Dr.Diab. (November 1, 2017). Herpes zoster Pathogenesis Stages and Treatment Options. Medcoi Journal of Medicine, 12(2). urn:medcoi:article3231.

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