Herpes zoster, also known as shingles, is an infectious disease caused by the Varicella-Zoster Virus (VZV). The initial infection with this virus causes chickenpox. After recovery, the virus remains dormant in the nerve ganglia. When immunity decreases or certain triggers occur, the virus can reactivate and spread along nerve pathways, leading to the characteristic symptoms of herpes zoster. This disease is more common among middle-aged and elderly populations, but it can occur at any age.
The hallmark of herpes zoster is the appearance of clustered vesicular rashes on one side of the skin, often accompanied by severe pain. Although the skin lesions eventually heal, some patients may experience long-term complications such as postherpetic neuralgia (PHN). Recent medical studies show that early diagnosis and treatment can significantly reduce the risk of complications, making public awareness of this disease crucial.
The direct cause of herpes zoster is the reactivation of the Varicella-Zoster Virus. After the initial chickenpox infection, the virus remains permanently latent in the dorsal root or cranial nerve ganglia. When immune function is weakened due to aging, chronic illness, stress, or specific treatments such as chemotherapy, the virus may reactivate, travel along nerve fibers to the skin, and cause inflammation.
Main risk factors include:
Herpes zoster symptoms typically appear in stages. The initial stage may include nonspecific symptoms such as low-grade fever, dizziness, and general fatigue, which can last several days. This is followed by pain, burning, or abnormal sensations in a specific nerve distribution area, often before skin changes occur.
Characteristic skin symptoms include redness along a unilateral nerve distribution, followed by clustered vesicles. These skin lesions usually appear in a band-like pattern over the intercostal nerves, trigeminal nerve, or sacral nerve areas. The vesicles may last 7-10 days before crusting over, but pain can persist for weeks to years, leading to postherpetic neuralgia. Other symptoms may include regional lymphadenopathy, fever, and in severe cases, bacterial superinfection.
The diagnosis of herpes zoster mainly relies on clinical presentation and skin examination. Physicians will assess the typical rash morphology, nerve distribution, and medical history. When symptoms are atypical or differentiation from other skin conditions is needed, the following tests may be performed:
Differential diagnosis should distinguish herpes zoster from herpes simplex, cellulitis, other neuralgic pain conditions, and more. Patients with immunodeficiency or severe symptoms should undergo systemic evaluation to assess underlying immune status. Early accurate diagnosis is critical for prognosis.
The goal of treatment is to suppress viral replication, alleviate symptoms, and prevent complications. Antiviral medications such as acyclovir, valacyclovir, are first-line treatments and should be initiated within 72 hours of rash onset for optimal efficacy. Analgesics such as NSAIDs, tricyclic antidepressants, or anticonvulsants can effectively control neuralgia.
Local treatments include cleaning the affected area, cold compresses to reduce inflammation, and topical anesthetic creams to relieve pain. Severe cases may require corticosteroids to suppress inflammation, but caution is needed to avoid immunosuppression. Recent studies suggest that interferon injections or nerve block therapies may have potential benefits for intractable postherpetic neuralgia.
Vaccination is a key measure to prevent herpes zoster and its complications. Currently, two vaccines are available:
Routine preventive measures include maintaining a balanced diet, regular exercise to boost immunity, and avoiding contact with chickenpox patients to prevent viral reactivation. Patients with chronic illnesses should regularly monitor their condition and avoid abrupt discontinuation of immunosuppressive drugs. Even after vaccination, maintaining a healthy lifestyle is important, as vaccine protection lasts about 10 years.
Seek medical attention immediately if you experience any of the following:
If the symptoms involve the trigeminal nerve, ear, or eye, urgent medical attention is necessary to prevent serious complications. Even mild symptoms should prompt early consultation to take advantage of the antiviral treatment window within 72 hours.
The rash of herpes zoster typically crusts over and heals within 2 to 4 weeks, but the exact duration varies among individuals. Extensive rashes or improper treatment may prolong healing. Most patients do not leave obvious scars after healing, but scratching or secondary infection can cause minor pigmentation changes or scars. It is recommended to avoid scratching and follow medical advice.
Can herpes zoster recur after healing? How can recurrence be reduced?Herpes zoster usually does not recur in the same dermatome, but in rare cases, it may occur in different areas. To reduce recurrence risk, vaccination (such as herpes zoster vaccine), maintaining regular routines, a balanced diet, and moderate exercise to strengthen immunity are advised. Elderly or immunocompromised individuals should consult their doctor for preventive vaccination.
What treatments are available for persistent postherpetic neuralgia?Postherpetic neuralgia can last for months or years. Treatments include anticonvulsants (e.g., gabapentin), antidepressants (e.g., duloxetine), or topical anesthetic patches. Severe cases may consider nerve blocks or transcutaneous electrical nerve stimulation (TENS). Early medical consultation and personalized treatment plans can effectively relieve symptoms.
Does stress trigger herpes zoster or worsen its symptoms?Prolonged stress can weaken immune function, potentially reactivating the Varicella-Zoster Virus and causing herpes zoster. Stress may also exacerbate redness, swelling, or nerve pain. Relaxation techniques such as meditation, exercise, or counseling are recommended, especially during high-stress periods.
How long does the protection from herpes zoster vaccines last? What precautions should be taken after vaccination?The protective effect of vaccines like Zostavax® or Shingrix® varies, generally lasting over 5 years, but may be shorter in immunocompromised individuals. After vaccination, maintaining good hygiene, avoiding contact with immunodeficient persons, and regularly monitoring immune status are advised. Discuss with your doctor about booster doses if necessary.
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