Herpes zoster (shingles) on the anterior chest, classic dermatomal distribution.

Varicella zoster virus (VZV)

Clinical manifestation
Shingles: erythematous maculopapular rash along dermatomal planes, pain, pruritus
Ocular: progressive outer retinal necrosis (PORN)
Herpes Zoster (Shingles)

Etiologu and pathophysiology

Activation of the varicella-zoster virus. Incidence increases with age. Potentially contagious to anyone who has not had varicella or who is
immunosuppressed. >1 million cases annually in the United States.

Clinical manifestation
Linear distribution along a dermatome of grouped vesicles and pustules on erythematous base resembling chickenpox.
Usually unilateral on trunk, face, and lumbosacral areas. Burning, pain, and neuralgia preceding outbreak. Mild to severe pain during outbreak (see
Fig. 24-7).

Treatment and prognosis

Symptomatic. Antiviral agents such as acyclovir, famciclovir, and valacyclovir within 72 hr to prevent postherpetic neuralgia. Wet
compresses, silver sulfadiazine (Silvadene) to ruptured vesicles. Analgesia. Mild sedation at bedtime. Gabapentin (Neurontin) to treat
postherpetic neuralgia. Usually heals without complications, but scarring and postherpetic neuralgia possible. Vaccine (Zostavax) to prevent shingles
is available for adults ≥50 yr.