Review on Herpes Zoster

Abstract

The Varicella-Zoster Virus (VZV), which is latent in the dorsal root ganglia following a first infection (chickenpox), can reactivate to cause Herpes Zoster, sometimes referred to as shingles. It usually appears as a severe, vesicular rash that is limited to a single dermatome and mostly affects elderly adults and immunocompromised people. In addition to causing severe neuropathic pain, the condition can cause secondary bacterial infections, ocular involvement, and post herpetic neuralgia (PHN). To lessen the intensity and duration of symptoms, prompt identification and antiviral medication beginning are crucial.The frequency and consequences of illness in older people have been considerably decreased by immunization advancements, especially the recombinant zoster vaccine (Shingrix). Despite these developments, there are still difficulties in treating chronic pain and creating treatments that target dormant viral reservoirs. In addition to outlining current issues and potential research avenues for better patient care, this review covers the aetiology, pathophysiology, clinical characteristics, diagnosis, treatment options, and recent advancements in the prevention and management of herpes zoster.

Introduction

Herpes Zoster, commonly known as shingles, is a painful, blistering rash that typically appears in a band-like pattern on one side of the body or face. It is caused by the reactivation of the Varicella-Zoster Virus (VZV), the same virus that causes chickenpox. After an initial infection, the virus remains dormant in sensory nerve ganglia and can reactivate later, especially in older adults or immunocompromised individuals.

Key Sections:

Etiology:

• VZV remains dormant in nerve ganglia after chickenpox.

• Reactivation risk increases with age, immunosuppression, stress, and chronic illnesses.

• Transmission from shingles can cause chickenpox in unvaccinated individuals, not shingles.

Pathophysiology:

• Virus reactivates when cell-mediated immunity weakens, travels along nerves, and causes inflammation and nerve damage.

• This can lead to acute neuritis and Postherpetic Neuralgia (PHN)—a long-term pain condition.

• In severe cases, the virus may affect internal organs, causing complications like encephalitis.

Symptoms:

• Begins with burning or tingling pain, followed by a unilateral rash that turns into fluid-filled blisters.

• The rash resolves in 2–4 weeks but may leave behind chronic nerve pain (PHN), especially in older adults.

• Serious forms affect eyes (ophthalmic) or facial nerves (Ramsay Hunt syndrome).

Diagnosis:

• Primarily clinical, based on rash and pain in a single dermatome.

• PCR testing confirms cases, especially in atypical or immunocompromised patients.

• Other methods: Tzanck smear, DFA, viral culture (less common).

Risk Factors:

• Age 50+, weakened immunity, HIV/AIDS, cancer, autoimmune diseases, stress, and chronic illnesses (like diabetes).

• Possible links to genetic factors and family history.

Treatment:

• Antivirals (acyclovir, valacyclovir, famciclovir) are most effective when started within 72 hours of rash onset.

• Pain management includes NSAIDs, anticonvulsants (gabapentin, pregabalin), antidepressants, and topical agents.

• Corticosteroids may help but do not reduce PHN risk.

• Eye or cranial nerve involvement requires specialist care.

Future Research Directions:

• Development of better vaccines, especially for high-risk populations.

• New antivirals with improved safety and efficacy.

• Gene-editing technologies (e.g., CRISPR) to target latent virus.

• Improved treatments and prediction tools for PHN.

• Expanded public health efforts in awareness and affordable vaccination programs.

Conclusion

Vaccination, especially with the Shingrix vaccine, has emerged as a highly effective preventive tool, drastically reducing the incidence and severity of herpes zoster and its complications. Future research holds promise in refining treatment protocols, understanding the virus\'s latency mechanisms, and developing more robust preventive strategies. In conclusion, a multifaceted approach involving early detection, patient education, effective vaccination, and continued research is essential for reducing the global impact of herpes zoster. The frequency and severity of herpes zoster and its sequelae have been significantly reduced by vaccination, particularly with the Shingrix vaccine. Future studies might help improve treatment regimens, comprehend the mechanics underlying the virus\'s latency, and create stronger preventative measures. In conclusion, minimizing the worldwide impact of herpes zoster requires a multimodal strategy that includes early identification, patient education, efficient immunization, and ongoing research.

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Copyright

Copyright © 2025 Ms. Shruti Balasaheb Choure, Ms. Rushali Bedjawalge, Mr. Nitin Gawai, Ms. Vaishnavi Gavhane, Mr. Vivek Patil. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.