Herpes zoster

Herpes zoster is an acute viral disease caused by the reactivation of latent varicella-zoster virus (VZV) – the same virus that causes chickenpox. After chickenpox, the virus remains dormant in sensory nerve ganglia and, under certain conditions, can reactivate, causing shingles.

Risk factors for reactivation
- Advanced age (most often >50 years)
- Immunosuppression (e.g. after chemotherapy, HIV infection, transplantation)
- Stress and physical exhaustion
- Oncological and autoimmune diseases
- Trauma or surgery in the area of the affected nerve

Clinical picture
- Pain, burning, tingling, or increased sensitivity in a specific dermatome (area innervated by a single nerve)
- After 1–3 days: appearance of grouped blisters on a reddened base, usually on one side of the body
- Most common areas: chest, abdomen, neck, face
- Lesions crack, crust over, and heal in 2–4 weeks
- When affecting the face – possible involvement of the eyes (zoster ophthalmicus) or ears (zoster oticus)

Complications
- **Postherpetic neuralgia:** persistent pain in the skin after skin lesions have healed – most common in adults
- Bacterial superinfection
- Eye involvement – risk of vision loss
- Disseminated zoster in immunosuppressed patients

Diagnosis
- Clinical – based on the characteristic rash and location in a dermatomal pattern
- PCR or direct immunofluorescence – in case of atypical picture
- Differential diagnosis: impetigo, herpes simplex, allergic contact dermatitis

Treatment
**Antiviral therapy:**
- Acyclovir, valacyclovir, famciclovir – start within 72 hours of first symptoms

**Pain relief therapy:**
- NSAIDs (ibuprofen, diclofenac)
- For severe pain – pregabalin, gabapentin, antidepressants (at the discretion of the doctor)

**Maintenance care:**
- Local antiseptics
- Keeping the skin clean and dry

Prevention
- Good control of chronic diseases and stress
- Isolation for active blisters – to protect unimmunized individuals against chickenpox

Shingles is a serious but treatable disease. Early recognition and initiation of therapy significantly reduce the risk of complications, including postherpetic neuralgia. Consulting a doctor is key to proper management.