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Last Updated: 2/24/2014  

Herpes Zoster

Prevention
  • Recommend VZV vaccination for immunocompetent adults aged 60 years and older, regardless of whether they report a prior episode of herpes zoster.

  • Administer either varicella-zoster immune globulin or varicella vaccine to patients without evidence of immunity to varicella after exposure to varicella or herpes zoster.

    • Because of the incomplete information about the safety of the live-virus vaccine during pregnancy and for immunocompromised individuals, postexposure passive immunization with varicella-zoster immune globulin, not vaccination, is recommended for these populations.

Diagnosis
  • Look for the characteristic cutaneous eruption of herpes zoster during clinical exam.

  • The typical vesicular rash that follows a defined dermatomal pattern and is accompanied by neuralgic pain is quite distinctive and mimicked by few other diseases.

  • Alternative diagnoses should be considered in patients whose syndrome does not conform with this presentation.

  • Conduct confirmatory laboratory testing for patients in whom the clinical diagnosis of herpes zoster is not obvious.

Therapy
  • Ensure that the cutaneous lesions are kept clean and dry to reduce the risk of bacterial superinfection.

  • Consider using a sterile, occlusive, nonadherent dressing to protect the lesions and promote healing, especially in patients with herpes zoster with increased skin sensitivity.

  • Prescribe antiviral therapy to patients who present within 72 hours after the onset of herpes zoster.

  • Treat patients with herpes zoster ophthalmicus with antiviral therapy even if lesions have been present for more than 72 hours.

  • Establish adequate pain control in patients with herpes zoster.

  • Administer intravenous acyclovir in patients with herpes zoster complicated by central nervous system involvement.

Follow-up
  • Recognize that patients with postherpetic neuralgia require close follow-up for management of chronic pain.

  • Recognize that late complications can occur such as neurologic complications, multifocal vasculopathy, and acute retinal necrosis.

DOI: 10.7326/d636
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
John W. Gnann, Jr., MD is a consultant for Astellas, received honorarium from Merck, GlaxoSmithKline, received grants from Novartis, Merck. Mazen Bader, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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