Shingles (Herpes Zoster)
Shingles is reactivation of latent varicella-zoster virus in a sensory ganglion, usually causing a painful unilateral dermatomal rash; treat eligible patients promptly, recognise ophthalmic, neurological and disseminated disease, manage post-herpetic neuralgia, and offer current Shingrix vaccination to eligible cohorts.
Definition
Shingles, or herpes zoster, is reactivation of latent varicella-zoster virus in a sensory ganglion causing a painful vesicular eruption in one or more dermatomes. Important complications include post-herpetic neuralgia, ophthalmic and neurological disease, Ramsay Hunt syndrome and disseminated infection.
First principles
Reactivation follows waning cell-mediated immunity
After chickenpox, varicella-zoster virus remains latent in sensory ganglia. Reactivation is more likely with age, immunosuppression or other loss of cell-mediated immunity. Viral spread along a sensory nerve produces neuritis and a unilateral dermatomal eruption, but severe immunosuppression can produce multidermatomal or disseminated disease.
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