Pain is the preliminary sign of herpes zoster. Few days later, skin rashes develop only on one side of the body affecting one or more skin dermatomes. In many cases, the rash develops on the left or right side of the torso. However, many individuals may develop the rash on one side of the neck or face or around the eyes. In addition to these, other signs and symptoms of herpes zoster include the following [7]:

• Burning accompanied by tingling sensation in the affected area
• Pruritic rashes 
• Skin rash with blisters that break and develop crust
• Individuals with herpes zoster also suffer from fever, fatigue and headache

• Pain

  Measures of pain burden that reflect the area under the pain intensity—pain duration curve [ 9, 20 ] were calculated by multiplying the pain intensity composite scores and the sensory and affective pain scores by the estimated number of days with pain [dx.doi.org]

  an unpleasant abnormal sensation, spontaneous or evoked; allodynia, pain evoked by a normally innocuous stimulus; and hyperalgesia, pain of exaggerated severity in response to normally painful stimulation. 14, 15 The pain itself has been described as [web.archive.org]

• Fever

  No participant had grade 3 fever in either of the groups. [doi.org]

  The morphology of the lesions included erythematous papules, pseudovesicles, and plaques, with associated pain in two and pruritus in three patients; systemic symptoms ranged from none to low-grade fevers, upper respiratory symptoms, and joint pain. [ncbi.nlm.nih.gov]

  Symptoms of shingles include: A painful rash and blisters on 1 side of the face or body Fever Headache Chills Upset stomach Shingles can’t spread from person to person like chickenpox. [vaccines.gov]

• Fatigue

  There were no differences in the incidence of the following AEs: any fatigue, grade 3 fatigue, any fever, any headache, any myalgia, grade 3 myalgia, local grade 3 pain, local grade 3 redness, consent withdrawal, loss to follow‐up and serious AEs. [doi.org]

  In addition, shingles may cause headache, fatigue, fever, and a general achy feeling. Individuals experiencing the aforementioned symptoms should seek medical attention. [illinoisderm.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019 [patientslikeme.com]

  Vaccine side effects with Shingrix are most commonly muscle aches, fatigue, fever, and shivering. Approximately 1 in 6 persons have symptoms severe enough to prevent them from engaging in regular activities. [tripprep.com]

  This may happen due to normal aging, or the body's immune system may become weakened due to stress from illness, physical or emotional stress, fatigue, poor nutrition, certain medications, chemotherapy, radiation therapy, or other factors. [curlie.org]

• Malaise

  The typical clinical manifestation is an acute segmental eruption of herpetiform umbilicated vesicles associated with malaise, pain, dysaesthesia, allodynia and probably fever. [ncbi.nlm.nih.gov]

  In the initial stage of herpes zoster (ie, prodromal phase), patients may experience headache, pain, malaise, and acute photophobia before the rash appears. [jaoa.org]

  Other symptoms include headache, sensitivity to light, and malaise. [tripprep.com]

• Chills

  Other symptoms of shingles can include Fever Headache Chills Upset stomach [cdc.gov]

  You begin to have symptoms of a secondary infection, such as a very high fever, chills, and severe headache. [verywell.com]

• Abdominal Pain

  A 72-year-old man presented with abdominal segmental hernia, constipation, and pain following HZ in the left T9-10 dermatome. Sixteen days before presentation, he had developed a painful herpetic rash in the left upper abdominal quadrant. [ncbi.nlm.nih.gov]

  The most common side effects include headache, abdominal pain, vomiting and diarrhea. The treatment may also provide more serious symptoms such as confusion, hallucinations and affected alertness. [firstderm.com]

  On post-operative day one, he developed worsening abdominal pain. An urgent exploratory laparotomy revealed no abnormalities. Over the next few days, he experienced worsening confusion and agitation. [the-hospitalist.org]

  Mattila Leena, Valtonen Ville and Anttila Veli-Jukka, Visceral varicella zoster virus infection after stem cell transplantation: a possible cause of severe abdominal pain, Scandinavian Journal of Gastroenterology, 41, 2, (242), (2006). [doi.org]

• Severe Abdominal Pain

  Mattila Leena, Valtonen Ville and Anttila Veli-Jukka, Visceral varicella zoster virus infection after stem cell transplantation: a possible cause of severe abdominal pain, Scandinavian Journal of Gastroenterology, 41, 2, (242), (2006). [doi.org]

  Visceral varicella zoster virus infection after stem cell transplantation: A possible cause of severe abdominal pain. Scan J Gastroenterol 2006;41:242-4. 78. Hyland JM, Butterworth J. Severe acute visceral pain from varicella zoster virus. [e-ijd.org]

• Acute Abdomen

  Visceral varicella zoster after bone marrow transplantation: an obscure cause of an "acute abdomen". Dig Dis Sci 2002;47:1962-4. 82. Berman JN, Wang M, Berry W, Neuberg DS, Guinan EC. [e-ijd.org]

  Acute abdomen and intestinal necrosis produced by varicella-zoster virus in an immunocompromised host. Clin Infect Dis 1996. 22:857–858. [Google Scholar] Dubrovsky, T., R. Curless, and G. Scott. et al. [archivesofpathology.org]

• Jaw Pain

  […] arm/hand pain, jaw pain. [en.wikipedia.org]

• Chest Pain

  Pressure, fullness, squeezing or pain in the center of the chest. [en.wikipedia.org]

  These include shortness of breath, fever, cough (occasionally hemoptysis), pleuritic chest pain, and signs of hypoxia. [journals.sagepub.com]

  Five days before, the patient was evaluated for left axillary chest pain and nausea. The finding on the initial workup was negative. His medical history included type 2 diabetes mellitus complicated by peripheral neuropathy. [journals.lww.com]

• Otalgia

  Involvement of facial nerve leads to otalgia, lower motor neuron homolateral facial paralysis, and vesicular eruptions in auricle. [ncbi.nlm.nih.gov]

• Anterior Uveitis

  uveitis present IOP raised B3: management to resolution if co-managed with GP and keratitis mild and limited to epithelium Requires careful monitoring. [college-optometrists.org]

  Onset between 3 months and several years after the onset of the rash.[5] Uveal[edit] Anterior uveitis develops in 40–50% of cases with HZO within 2 weeks of onset of the skin rashes. [en.wikipedia.org]

  UVEITIS Anterior uveitis, which is diagnosed by slit lamp examination, refers to inflammation of the iris and ciliary body and occurs frequently with herpes zoster ophthalmicus. It may be isolated or associated with keratitis. [web.archive.org]

• Eye Pain

  Continued Shingles Complications Shingles can have complications that last long after the rash is gone, including: Brain inflammation or facial paralysis if it affects certain nerves Eye problems and vision loss if your rash was in or around your eye [webmd.com]

  […] per year (US)[3] Herpes zoster ophthalmicus (HZO), also known as ophthalmic zoster, is shingles involving the eye.[1] Symptoms generally include a rash of the forehead with swelling of the eyelid.[1] There may also be eye pain, eye redness, and light [en.wikipedia.org]

  Eye damage. The facial weakness caused by Ramsay Hunt syndrome may make it difficult for you to close your eyelid. When this happens, the cornea, which protects your eye, can become damaged. This damage can cause eye pain and blurred vision. [mayoclinic.org]

  Some people may find it hard to close one eye, which can eventually damage the cornea, leading to eye pain and vision problems. Some patients may experience pain long after other symptoms have gone, in a condition known as postherpetic neuralgia. [medicalnewstoday.com]

• Eye Swelling

  ICE has three main features: Visible changes in the iris, the colored part of the eye Swelling of the cornea Glaucoma ICE is usually present in only one eye. It is caused by the movement of endothelial cells from the cornea to the iris. [nei.nih.gov]

• Back Pain

  The virus may spread to other nerves, such as the brain and spinal cord, causing confusion, lethargy, back pain, weakness in the arms and legs, and headaches. [medicalnewstoday.com]

  Tell your doctor or pharmacist if you notice any of the following and they worry you: dry mouth fever difficulty sleeping chills back pain nervousness skin rash which may be itchy weakness Some rare side effects of VACLOVIR include: sensitivity to UV [news-medical.net]

  […] ooze, in the genital area leg or lower back pain painful burning urination Both herpes and HPV can lie dormant, meaning that the infection is still present in the body without any symptoms. [healthline.com]

  […] may contribute to problems sleeping. 17 Postherpetic neuralgia is the third most common cause of neuropathic pain in the United States, behind neuropathic low back pain and diabetic neuropathy. 18 Postherpetic neuralgia is of varying duration and develops [web.archive.org]

  Another study indicated that 0.5% of patients with confirmed zoster were hospitalized before their zoster rash developed for prodromal pain syndromes including suspected myocardial infarction, severe new-onset headache, back pain, and abdominal pain resulting [cdc.gov]

• Shoulder Pain

  Stefano Gumina, Vittorio Candela, Daniele Passaretti and Ciro Villani, Shoulder pain due to cervical radiculopathy: an underestimated long-term complication of herpes zoster virus reactivation?, International Orthopaedics, 42, 1, (157), (2018). [doi.org]

• Low Back Pain

  […] may contribute to problems sleeping. 17 Postherpetic neuralgia is the third most common cause of neuropathic pain in the United States, behind neuropathic low back pain and diabetic neuropathy. 18 Postherpetic neuralgia is of varying duration and develops [web.archive.org]

• Blister

  blisters often leave no scars. [ninds.nih.gov]

  The virus is spread through direct contact with fluid from the rash blisters caused by shingles. A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. [web.archive.org]

  Most often, blisters appear on the trunk, usually on only one side. However, a few blisters may also appear elsewhere on the body. Typically, blisters continue to form for about 3 to 5 days. [msdmanuals.com]

• Eruptions

  The time of complete resolution of pain, time of healing of skin eruption, and incidence of PHN were reported. [ncbi.nlm.nih.gov]

  Presentation The disease can be divided into the pre-eruptive phase, acute eruptive phase and chronic phase - postherpetic neuralgia (PHN). [patient.info]

  Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. [doi.org]

• Skin Rash

  Different nerves can be included with the skin rash in the area of its enervation especially cranial nerves (CV) and intercostal nerves. [ncbi.nlm.nih.gov]

  Few days later, skin rashes develop only on one side of the body affecting one or more skin dermatomes. In many cases, the rash develops on the left or right side of the torso. [symptoma.com]

  skin shingles picture, pictures of shingles blisters, shingles photos, medical shingles, free journal articles, shingles rash pictures, pictures of shingles rash, shingles skin rash pictures, pictures of shingles skin rash, shingles images, shingles [hardinmd.lib.uiowa.edu]

  Eye problems from herpes zoster may appear at the same time as the skin rash or weeks after the lesions have disappeared. [umkelloggeye.org]

• Vesicular Rash

  No vesicular rash was observed on the patient's face, and magnetic resonance imaging of the brain showed no pathology. [ncbi.nlm.nih.gov]

  We describe a case of segmental zoster paresis that presented acutely as loss of function of the right lower limb with the appearance of a vesicular rash occurring at the same time, and full restoration of function with resolution of the rash. 2. [hindawi.com]

  Reactivation causes the typical dermatomal pain and vesicular rash (fig 1). [bmj.com]

• Eczema

  […] avoid chronic conditions, such as postherpetic neuralgia. 8.1 Antiviral therapy Indication for anti-viral treatment patient >50 years patients of any age if head/neck area is affected patients under immune suppression therapy patients with (atopic) eczema [flexikon.doccheck.com]

  Types & treatments Childhood eczema Adult eczema Insider secrets Types of hair loss Treatment for hair loss Causes of hair loss Hair care matters Insider secrets What is psoriasis Diagnosis & treatment Skin, hair & nail care Triggers Insider secrets What [aad.org]

  The rash, especially if without pain, may be mistaken for atopic eczema, eczema herpeticum, contact dermatitis, herpes simplex or impetigo. Diagnosis of eczema/dermatitis may lead to this viral infection being treated with steroid cream. [patient.info]

• Facial Pain

  The medical term for head or facial pain due to shingles is "painful trigeminal neuropathy attributed to herpes zoster." [verywell.com]

  Persistent idiopathic facial pain. Temporomandibular disorders. Otitis (externa or media). Referred pain (eg, dental abscess). Carcinoma of the nasopharynx. [patient.info]

  […] two thirds of the tongue.9 Another significant contribution was Hunt's description of a painful neuralgia that occurred with facial paralysis and zoster oticus. [jnnp.bmj.com]

  Differential diagnosis – trigeminal neuralgia, maxillary sinusitis, periodic migrainous neuralgia, atypical facial pain. [journals.lww.com]

  In patients with PHN, pain ranks very high compared with pain from other chronic conditions such as atypical facial pain, osteoarthritis and rheumatoid arthritis [30]. [bmcmedicine.biomedcentral.com]

• Neuralgia

  Although postherpetic neuralgia has been defined in different ways, recent data support the distinction between acute herpetic neuralgia (within 30 days of rash onset), subacute herpetic neuralgia (30-120 days after rash onset), and postherpetic neuralgia [web.archive.org]

  Five reported mild postherpetic neuralgia, one had moderate pain, and no patient reported severe neuralgia at the end of follow up. [dx.doi.org]

• Headache

  No participant had grade 3 fever, grade 3 headache and local grade 3 swelling in either of the groups. [doi.org]

  Other symptoms of shingles can include Fever Headache Chills Upset stomach [cdc.gov]

  Shingles is a localised, painful vesicular rash which may follow a headache, tiredness and itching or tingling in the affected area, and is a reactivation in the body of the same virus that caused chickenpox earlier in life. [sahealth.sa.gov.au]

  You begin to have symptoms of a secondary infection, such as a very high fever, chills, and severe headache. [verywell.com]

• Burning Sensation

  Some people describe the pain as an intense burning sensation. For some people, the pain can last for months or even years after the rash goes away. [cdc.gov]

  Symptoms of Herpes Zoster The first symptoms of herpes zoster are usually pain and burning sensations. In some patients, even the slightest touch or having clothing touch or rub against the skin can cause pain. [bumrungrad.com]

  Iris versicolor This remedy is often helpful for herpes zoster infection that is accompanied by stomach problems with burning sensations and nausea. Eruptions may appear especially on the right side of the abdomen. [uofmhealth.org]

  Signs and Symptoms: Early signs of shingles include a burning sensation or stabbing pain and tingling or itching on the skin. After a few days, a rash or blisters appear usually on one side of the body or face. [conditions.health.qld.gov.au]

• Guillain-Barré Syndrome

  Shingles can also cause lead to other complications, including eye damage, bacterial infections, and Guillain-Barré syndrome. There is a childhood vaccine against chicken pox, but there is also an adult vaccine against shingles. [verywellhealth.com]

  Other potential complications of HZ include ophthalmic sequelae (herpes zoster ophthalmicus), central nervous system infection, nerve palsies including the Ramsay-Hunt Syndrome, neuromuscular disease including Guillain-Barré Syndrome, pneumonia, hepatitis [canada.ca]

  […] mortality rate of 5% to 15%, with most deaths attributable to pneumonia.6,7 The neurologic complications of HZ may include acute or chronic encephalitis, myelitis, aseptic meningitis, polyradiculitis, retinitis, autonomic dysfunction, motor neuropathies, Guillain-Barré [ncbi.nlm.nih.gov]

  Severe Guillain-Barré syndrome following primary infection with varicella zoster virus in an adult. Int J Infect Dis. 2010 Feb. 14(2):e161-3. [Medline]. Shapiro JS. [emedicine.com]

• Hyperesthesia

  This pattern is called zoster sine herpete (zoster without rash) and affected patients have severe pain of abrupt onset and hyperesthesia over a specific dermatome. [ncbi.nlm.nih.gov]

  It is known that, with previous varicella infection, the virus lies dormant in the dorsal root ganglia and, on reactivation, results in the commonly described sensory symptoms of hyperesthesia or paraesthesia in the affected dermatome [1]. [hindawi.com]

  Patients will typically experience 1-2 days of pain, itching, and hyperesthesia before the skin lesions are noticed.[3] [1] Etiology/Causes Herpes Zoster is caused by the dormant varicella-zoster, also known as chickenpox, becoming active again, often [physio-pedia.com]

  […] pathologic studies have demonstrated damage to the sensory nerves, the sensory dorsal root ganglia and the dorsal horns of the spinal cord in patients with this condition. 9 Clinical Presentation Herpes zoster typically presents with a prodrome consisting of hyperesthesia [web.archive.org]

Physical examination of the skin rashes and its characteristics forms the basis of the diagnosis. In addition, history of pain and the appearance of rash on one side of the body confirm herpes zoster. In many instances, tissue scrapings can be cultured for the virus, but such a kind of method is time consuming and delays diagnosis and consequent initiation of treatment.

Laboratory tests are of no importance in diagnosing herpes zoster. Also, no type of imaging studies is indicated in diagnosis of the condition. However, MRI can be carried out in cases when there is development of encephalopathy and myelopathy.

• Vibrio Vulnificus

  Tyring, Vibrio Vulnificus Necrotizing Fasciitis Preceding Herpes Zoster, Baylor University Medical Center Proceedings, 26, 1, (55), (2013). [doi.org]

Herpes zoster cannot be cured; the symptoms can however be managed with antiviral drugs. These medications also reduce the risk of developing complications. Antiviral drugs such as famciclovir, valacyclovir and acyclovir are prescribed for effective management of the rash and blisters [8].

Along with antiviral drugs, numbing agents such as lidociane are also given in form of cream or gel to be applied on the affected area. In order to control the associated symptoms of herpes zoster, steroid injections can also be administered to shorten the duration of the episode [9].

The prognosis of the disease condition is extremely favorable with the rash that resolves within 10 to 15 days. Children and otherwise healthy individuals have a better prognosis as compared to the elderly population [5]. However, if treatment is not initiated in right time, it can cause debilitating and life threatening complications in the immunocompromised population [6].

The virus known as varicella zoster virus (VZV) causes herpes zoster. The VZV virus belongs to the Herpesviridae family. The exact etiology that causes the reactivation of the virus years after initial exposure is not yet known. However, individuals with poor immunity status are known to fall easy prey to this disease. Certain disease conditions such as HIV and cancer can predispose the individual to develop herpes zoster [2].

It has been estimated that in the US, about 99.5% adult aged 40 years and above are susceptible to reactivation of VZV. An individual of any age group who has suffered varicella early in life is susceptible to develop herpes zoster as they age. It happens probably because of lowered immunity. It has also been reported that, individuals who have suffered an attack of herpes zoster are at an increased risk of developing another attack of the disease later in the life. About 4% individuals are susceptible to develop recurrent attacks of herpes zoster [3].

The causative organism varicella zoster virus causes two discrete disease conditions, varicella and herpes zoster. Herpes zoster majorly occurs in those individuals who have suffered varicella early in their life. It is not a contagious disease, but individuals can pass on the virus to healthy individuals. As a result, the healthy individual would develop varicella and not herpes zoster.

After an episode of varicella, the virus remains in dormant state in the dorsal root ganglion. An attack of herpes zoster occurs, when the virus gets activated for reasons not clearly understood. However, certain factors such as decreased immunity or stress are known to predispose an individual to develop herpes zoster [4].

Herpes zoster can be prevented through vaccines namely varicella vaccine and varicella–zoster vaccine. The varicella vaccine used for prevention against chicken pox is now commonly used for children. This vaccine is also recommended for adults also who have never had chicken pox.

The FDA has approved the use of varicella–zoster vaccine for individuals aged 50 years and above. This vaccine significantly decreases the likelihood that individuals would develop herpes zoster. However, this vaccine is not indicated for individuals with weakened immune system [10].

An episode of herpes zoster is short lived and manifests as skin rashes in children and adults. Individuals who have suffered from varicella (chicken pox) can develop herpes zoster later in life. Once varicella is treated, the virus stays in dormant state inside the body and is not eliminated. Years after the initial exposure, the virus often causes episodes of herpes zoster [1].

Definition

Herpes zoster is a viral infection characterized by development of skin rashes with blisters specifically on one side of the body. The rash is confined to a small portion and appears as a single strap of blisters.

Cause

The virus known as varicella zoster virus causes herpes zoster. Individuals who had suffered from chicken pox early in their life are more prone to develop herpes zoster. The virus stays in dormant state in the body and gets activated when it gets favorable environment to grow. Individuals with poor immunity profile are at an increased risk of developing herpes zoster.

Symptoms

Individuals with herpes zoster develop painful rash along with blisters on one side of the body. In addition, certain percentage of affected population may also experience fever along with general weakness.

Diagnosis

No laboratory studies or imaging tests are useful in diagnosis of herpes zoster. Careful physical examination of the skin rashes and its characteristics helps in establishing a definite diagnosis of the condition.

Treatment

Antiviral agents along with corticosteroids are administered for treatment of herpes zoster. For providing relief from the uncomfortable symptoms of the rashes, numbing agents such as lidocaine are also given to be applied on the affected area.

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2. Whitley RJ, Weiss HL, Soong SJ, Gnann JW. Herpes zoster: risk categories for persistent pain. J Infect Dis 1999; 179:9.
3. Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, et al. Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med. Dec 2005;118(12):1416.
4. Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med 2002; 347:340.
5. Tseng HF, Chi M, Smith N, et al. Herpes zoster vaccine and the incidence of recurrent herpes zoster in an immunocompetent elderly population. J Infect Dis 2012; 206:190.
6. Schmader K, George LK, Burchett BM, Pieper CF. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis. Nov 1998;178 Suppl 1:S67-70.
7. Dolin R, Reichman RC, Mazur MH, Whitley RJ. NIH conference. Herpes zoster-varicella infections in immunosuppressed patients. Ann Intern Med 1978; 89:375.
8. Wood MJ, Shukla S, Fiddian AP, Crooks RJ. Treatment of acute herpes zoster: effect of early (< 48 h) versus late (48-72 h) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis. Nov 1998;178 Suppl 1:S81-4.
9. Fernandes NF, Malliah R, Stitik TP, Rozdeba P, Lambert WC, Schwartz RA. Herpes zoster following intra-articular corticosteroid injection. Acta Dermatovenerol Alp Panonica Adriat. Mar 2009;18(1):28-30.
10. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271.