Antiviral therapy for herpes zoster

What it is

Herpes zoster (shingles) is an acute, unilateral, painful blistering rash caused by reactivation of latent varicella zoster virus (VZV).

How it presents

The eruption is dermatomal (zosteriform) and on one side of the body, with grouped vesicles on an erythematous base, most often on the trunk but it can be anywhere, and it is usually preceded by pain or burning.

Two sites matter more than the rest. Herpes zoster ophthalmicus is reactivation in the area supplied by the ophthalmic division of the trigeminal nerve and accounts for around 10% of cases of shingles; the rash is vesicular and around the eye, and it may or may not involve the eye itself. Hutchinson's sign, a rash on the tip or side of the nose, indicates nasociliary involvement and is a strong risk factor for ocular involvement. Ramsay Hunt syndrome (herpes zoster oticus) is an acute unilateral facial palsy caused by reactivation in the geniculate ganglion, more common in the immunosuppressed and the elderly, with moderate to severe pain around the ear and vesicles in the auditory canal or auricle.