Herpes zoster, also known as shingles, is an acute viral infection caused by the varicella zoster virus which also causes chickenpox. It is characterized by a painful rash of blisters that typically occurs on one side of the body. The virus can reactivate decades after the initial chickenpox infection, causing shingles. Risk factors include older age and weakened immune systems. Treatment focuses on antiviral medication and management of postherpetic neuralgia. A shingles vaccine is recommended for older adults to prevent occurrence.

1. Herpes Zoster

2. Herpes Zoster
 Also known as Shingles
 An acute viral infection of the nerve
cells and surrounding skin.
 Characterized by a rash of blisters, can
be very painful but is not life-
threatening.
 Caused by the varicella zoster virus
that also causes chickenpox.

3. • Shingles usually appears, band of blisters on one
side of the chest or back, but it can occur anywhere
on the body, including on the face and near the eyes.

4. Varicella-zoster virus
 Varicella-zoster virus (VZV) infection causes two
clinically distinct forms of disease:
 Varicella (chickenpox)
 Herpes zoster (shingles)

5. Herpes virus (DNA)
Primary infection results in varicella (chickenpox)
Recurrent infection results in herpes zoster
(shingles)

6. Shingles Epidemiology
Transmission
• Direct contact with open sores of shingles rash
• Can pass to someone who has never had the chickenpox
High incidence groups
• Anyone who had chickenpox
• People over the age of 50
Incubation period
• 10–21 days

7. Pathophysiology
Herpes zoster
Infection of nerves and dermatome
Reactivation in dorsal root ganglia
Enter into nerve endings and transport to dorsal root ganglia (DRG) where it lies
DORMANT in sensory nerve ganglia, dorsal root.
Secondary viremia
Further viral replication in liver and spleen
Primary viremia in bloodstream
Viral replication in regional lymph nodes
VZV enters through the respiratory tract

11. Causes & Risk factors
Age
common in
people older
than 50.
Diseases
that weaken the
immune system,
such as HIV/AIDS
and cancer.
Cancer
treatments
Undergoing
radiation or
chemotherapy can
lower the resistance
to diseases and may
trigger shingles.
Immunosuppres
sant Drugs
prolonged use of
steroids, such as
prednisone.

12. Clinical Symptoms
Initial prodromal stage
The first signs of shingles may include
Headache
Feeling generally unwell
Myalgia
Fever

13. Acute stage
 A rash will begin to develop, often causing a
pain.
 Itching or tingling sensation in the area of the
affected nerve.
 A fluid filled painful rash then develops a few
days after and commonly occurs either on one
side of the face or body.
 Fluid-filled blisters that break open and crust
over
in 7-10 days and this clears within 2-4 weeks.

15. Complications
1. Post herpetic neuralgia
(PHN)
Post herpetic neuralgia can cause
severe nerve pain that persists after
the rash. PHN occurs most often in
elderly people and in people whose
immune systems have been
compromised.
2. Ophthalmic shingles
Shingles in or around an eye can
cause painful eye infections that

16.  Ramsay Hunt syndrome
Otherwise known as herpes zoster oticus,
inflammation of several of the nerves that
come out of the brain. The symptoms of
Ramsay Hunt syndrome are facial
ear pain.
 Encephalitis
 Hearing problems
 Bacterial infections on the

17. Cranial Nerve Involvement
I ophthalmic
II maxillary
III mandibular

18. Zoster Ophthalmicus

19. Shingles Diagnosis
Skin sample
Infected with varicella-zoster
virus
Blood test
Increase in white blood
cells

20. Management of acute herpes
zoster
 Antiviral medication to reduce pain and
complications. Should be started within 24
hours of first symptom .These
medications include:
 Acyclovir (Zovirax)
 Valacyclovir (Valtrex)
 Famciclovir (Famvir)

21. Management of Post herpetic
Neuralgia
 Tricyclic antidepressants, such
as amitriptyline.
 Opioids, such as methadone,
morphine.
 Lidocaine patch.
 Anticonvulsants, such as
gabapentin.
 Capsaicin cream.
 Topical anesthetics, including
benzocaine.

22. Non-pharmacologic treatment
Apply cool water compresses
to the skin or soak in a
bathtub filled with cool water
Add finely ground oatmeal to
the bathtub.
Apply calamine lotion to the
affected areas.
Trim your fingernails to avoid
infection.
Wear loose-fitting clothing.

23. Prevention
o Shingles vaccine (Zostavax)
 It is given to people 60 years of age and older who have already
had the chickenpox.
 The shingles vaccine is a live vaccine given as a single injection,
usually in the upper arm. The most common side effects of the
shingles vaccine are redness, pain, tenderness and swelling at
the injection site, and headaches.

24. Prognosis
• Many cases of shingles go away by
themselves, with or without treatment
• The rash and pain should be gone in two
to three weeks
• However, shingles may last longer and be
more likely to recur if the person is older,
especially older than 50 years of age, or
if they have a serious medical problem