This document discusses Herpes Zoster infection, also known as shingles. It is caused by reactivation of the varicella zoster virus, which also causes chickenpox. After initial chickenpox infection, the virus can remain dormant in nerve cells and reactivate later in life when immunity is weakened. Common symptoms include a painful rash with fluid-filled blisters localized to specific dermatomes. Management involves antiviral medication within 72 hours of rash onset to reduce pain and complications like postherpetic neuralgia. Vaccination is also recommended to prevent shingles in older adults who have had chickenpox.

1. Herpes Zoster Infection
Presented By
Mundhe Dhananjay Balaji
FinalYearB.Pharm
RollNo.60
PRN:- 1131920046416
Dattakala Shikshan Sanstha’s
Dattakala College of Pharmacy

2. Content
Introduction
Virus
Epidemiology
Pathophysiology
Causes and Risk Factors
Clinical Symptoms
Diagnosis
Acute Stage
Complications
Management of HZ
Treatment
Prevention
Prognosis
 Reference

3. Introduction
• Herpes zoster/shingles is a viral infection of the nerve cells
and surrounding skin, caused by the varicella zoster virus that
also causes chickenpox.
• After a person recovers from chickenpox infection, the virus
remains dormant in the nerve cells and can reactivate at a later
stage when the immune system is weakened.
• Reactivation can be associated with older age, having
chickenpox before 18 month of age or immunosuppression.

4. Herpes Zoster Virus
Herpes zoster, or shingles, is a common viral infection of the
nerves, which results in a painful rash of small blisters on a strip
of skin anywhere on the body. Even after the rash is gone, the
pain may continue for months. Shingles is relatively rare in
children.
Primary infection results in varicella (chickenpox).
Recurrent infection results in herpes zoster (shingles).

5. Varicella zoster virus
• Varicella-zoster virus (VZV) infection causes two
clinically distinct forms of disease:
1. Varicella (chickenpox)
2. Herpes zoster (shingle)

6. Signs And Symptoms
o The first signs of shingles may
include:
Headache
Feeling generally unwell
Myalgia
o Shingles Symptoms :
Red, blistering rash that typically
emerges along on side of the torso.
Burning, tingling, or pain in the affected
area.
Sensitivity to light
Fever and/or headache

7. Mode Of Transmission
Herpes zoster can be transmitted through direct contact,
specifically, through droplet infection and airborne spread.
 It can also be transmitted through indirect contact, e.g., articles
freshly soiled by secretions and discharges from an infected
person.

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

9. Causes and 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.
• Immunosuppresant Drugs:- Prolonged use of
steroids, such as prednisone.

10. Diagnosis
Diagnostic Exam
i. The characteristic skin rash may be diagnostic.
ii. Tissue culture technique- the virus may be isolated from fluid
taken from newly developing vesicles
iii. Smear of vesicle fluid
iv. Microscopy

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

12. Complications
 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
 Ophthalmic shingles:-
Shingles in or around an eye can cause painful eye
infections.

13. Management of HZ
Antiviral medication to reduce pain and complications. Should
be started within 24 hours of first symptoms.
These medications include:
o Acyclovir (Zovirax)
o Valacyclovir (Valtrex)
o Famciclovir (Famvir)

14. Management of Post Herpetic Neuralgia
Tricyclic antidepressants, such as amitriptyline.
Opioids, such as methadone, morphine.
Lidocaine patch.
Anticonvulsants, such as gabapentin.
Antidepressants , Seroxat 20
Capsaicin cream.
Topical anesthetics, including benzocaine.Benzodent

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

16. Medication
Conservative management
Antiviral: Acyclovir, famciclovir, valacyclovir within 72 h of
rash on skin
Corticosteroids: Prednisoone
Analgesics: NSAIDs, acetaminophen, opiods,
Topical therapy: Lidocaine, 8% capsaicin, acyclovir ointment
Combination therapy: Acyclovir + UVB, acyclovir
prednisolone

17. Prevention
 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 headache

18. Continued…
Vaccine Storage and Handling
Before reconstitution, both lyophilized antigen
component vials and adjuvant suspension component vials
should be stored refrigerated between 2°C and 8°C (36°F
and 46°F) and protected from light. After reconstitution, use
immediately or store refrigerated between 2°C and 8°C
(36°F and 46°F). Discard if not used within 6 hours of
reconstitution or if frozen. Manufacturer package inserts
contain additional information

19. 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.

20. References
1) https://medicine.umich.edu/sites/default/files/content/downl
oads/RockwellPamelaDecember5UpdateHerpesZoster.pdf
2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876683/
3) https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/he
rpes-zoster.pdf
4) https://www.slideshare.net/gohilvishal912/herpes-zoster-
52977690
5) https://www.slideshare.net/rozymea/herpes-zoster-shigella-
ncm-104