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Shingles and Postherpetic Neuralgia

Symptoms & Signs

  • Zoster
    • Onset of disease is often heralded by pain within the dermatome that may precede eruption of the rash by 2–3 days.
    • Prodrome can also include fever, malaise, and headache.
    • General characteristics of the rash
      • Most commonly involves a single, unilateral nerve root
      • Erythematous maculopapular rash evolves rapidly into vesicular lesions.
      • Lesions may remain few in number.
      • New lesions may continue to form for 3–5 days.
      • Rash is typically very pruritic and painful.
      • Usually lasts 7–10 days, though skin may not heal completely for 2–4 weeks
    • 3 clinical presentations
      • Unilateral vesicular eruption within a dermatome (most frequently between T3 and L3)
      • Zoster ophthalmicus (involvement of ophthalmic branch [V1] of the trigeminal nerve)
        • Pain and rash in the distribution of V1
        • Involvement of the eye is an ophthalmologic emergency.
        • Can lead to blindness if untreated
      • Ramsay Hunt syndrome (involvement of the facial nerve [cranial nerve VII])
        • Pain and vesicles appear in external auditory canal.
        • Ipsilateral facial palsy (upper and lower half of the face, resembling Bell’s palsy)
        • Loss of taste in the ipsilateral anterior two-thirds of the tongue
    • Immunocompromised host
      • Similar clinical presentations, though, can be more prolonged and more severe.
      • In immunocompromised patients who develop disseminated cutaneous zoster, there is the risk of involvement of the lungs (pneumonitis), central nervous system (meningoencephalitis), liver, and other organs.
        • Rarely fatal
  • Postherpetic neuralgia
    • Persistent pain and paresthesias in the dermatomal distribution of previous zoster rash
      • May be sharp, stabbing, burning, or aching
      • Can have either hypoesthesia or hyperesthesia on examination
      • Extreme sensitivity to touch and temperature changes

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[ Etiology ]Symptoms & Signs
Last updated: February 21, 2009
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