Herpes Zoster (shingles)

Herpes Zoster is a viral infection caused by the same virus that causes chicken pox. Illness, trauma, and stress may trigger a zoster attack. Symptoms include burning pain, tingling or extreme sensitivity in one area of the skin (usually limited to one side of the body), and then a red rash that turns into groups of blisters. The pain is often severe. If diagnosed early, anti-viral drugs may be prescribed and shorten the episode.
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What is the most important risk factor for zoster?

• Age is the most important risk factor for zoster.
• 99.5% of adults aged 40 years are at risk for zoster because they have had chickenpox.
• Nearly all adults over the age of 50 are at risk for zoster. Risk increases with age.

How do you know which patients will be affected by zoster?

You can’t know which patients will be affected by zoster.

There is no way to predict when the varicella-zoster virus will reactivate, who will develop zoster, or how severe any individual case may be.

According to the Centers for Disease Control and Prevention, approximately 1 in 3 people will experience zoster in their lifetime.

Nearly 1 million new cases of zoster are diagnosed in the United States each year.

An estimated 70% of the annual cases occur in people over the ages 50 years.

How do patients describe zoster?

Almost all patients experience more than a rash. Even though zoster generally presents as a rash, typically patients also experience pain. Pain can occur daily and be potentially severe.

In a 2004 study designed to describe the acute pain of zoster and assess its impact on patients.

• 96% of patients in this study experienced acute pain.
• 45% reported that they experienced pain every day.
• 42% reported that their worst zoster-associated pain was “horrible” or “excruciating”.

Are zoster complications common, and what are they?

Chronic pain is the most common complication of zoster.

Postherpetic neuralgia (PHN) is chronic pain that follows acute zoster. PHN can last for months or even years. Not everyone who experiences zoster suffers from PHN. The incidence of PHN increases with age. Patients have described PHN as: burning, throbbing, stabbing, shooting, and/or sharp pain.

In addition to PHN, other complications of zoster can vary in degree of severity:

• 10% to 25% of zoster patients suffer from ophthalmic zoster.
• 50% to 72% of patients who develop ophthalmic zoster will suffer chronic, recurring ocular disease and visual loss.