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Herpes Zoster (Shingles)

A painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. Wikipedia

About Shingles

When the itchy red spots of childhood chickenpox disappear and life returns to normal, the battle with the virus that causes chickenpox seems won. But for too many of us this triumph of immune system over virus is temporary. The virus has not been destroyed but remains dormant in our nerve cells, ready to strike again later in life. This second eruption of the chickenpox virus is the disease called shingles or herpes-zoster.

Most adults who have the dormant virus in their body never get shingles. The disease occurs when an unknown trigger causes the virus to become activated. NIH - National Institute for Neurological Disorders and Stroke

What works? Research summarized

Evidence reviews

[Evaluation of vaccine to prevent herpes zoster in adults: a systematic review of the literature]

Bibliographic details: Ruiz-Aragon J, Garcia-Cenoz M, Marquez-Pelaez S, Navarro Palenzuela C.  [Evaluation of vaccine to prevent herpes zoster in adults: a systematic review of the literature]. [Evaluacion de la vacuna para la prevencion del herpes zoster en adultos: revision sistematica de la literatura.] Vacunas 2014; 15(1-2): 13-20

Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review

OBJECTIVE: The objective of this study was to systematically review cost-effectiveness studies of vaccination against herpes zoster (HZ) and postherpetic neuralgia (PHN).

Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence

BACKGROUND AND OBJECTIVES: Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention.

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Summaries for consumers

Vaccines for preventing herpes zoster in older adults

The virus responsible for chickenpox, varicella zoster virus (VZV), can remain dormant inside nerve cells. Years later, when a person's immunity declines, for example because of aging, the virus may reactivate and travel through the nerve to the skin surface, producing clusters of blisters distributed along the path of the affected nerve, a condition called herpes zoster or shingles. Itching, numbness, tingling or localised pain precede the appearance of skin lesions. The virus causes inflammation of sensory nerves and can cause severe pain which impacts patients' quality of life. The annual incidence of herpes zoster is currently 5.22 episodes per 1000 older adults. This incidence is increasing, in part due to longer lifespan.

Vaccination for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat. Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required.

Uncertainty about usefulness of antiviral drugs in Ramsay Hunt syndrome

It seems logical that antiviral drugs might help patients with a herpes virus infection of the ear producing facial weakness (a condition known as 'Ramsay Hunt syndrome'). These drugs often help similar viral infections elsewhere in the body. However, trials that might address this issue have not been done and there is therefore some uncertainty about their usefulness. Since patients can experience side‐effects when taking these drugs, the risks of these have to be balanced with the unknown prospect of benefit when considering whether to use them in Ramsay Hunt syndrome.

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More about Herpes Zoster

Photo of an adult

Also called: Herpes-zoster, Zoster

See Also: Postherpetic Neuralgia

Other terms to know:
Viruses

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