Zoster (Shingles)

Risk factors: maternal varicella during pregnancy, or primary varicella in first year of life.

Herpes zoster ophthalmicus - involvement of cranial nerve V₁ occurs in 10-25% of herpes zoster (HZ) cases. Blisters on tip of nose may be seen. Consult ophthalmology.

Ramsay-Hunt syndrome - severe ear pain, facial muscle weakness, and rash indicates infection of facial nerve. Consult otolaryngologist.

Immunity is boosted once a person has herpes zoster, so recurrence is uncommon (≤ 5%) in immunocompetent persons.

Direct contact with the skin lesions of a person with regional/limited herpes zoster, or via airborne route in disseminated zoster, can lead to varicella (chicken pox) in persons who have not had varicella or been immunized.

Immunocompetent

- Therapy recommended if:

• ophthalmic involvement

• Ramsay-Hunt syndrome

• disseminated beyond two dermatomes.

- Topical therapy not recommended as ineffective.

- Therapy should be started within 72h of rash onset, or at any time if new vesicles forming or cutaneous/motor/neurologic/ocular complications.

Varicella zoster

Immunocompromised

- Therapy ideally should be started within 72h of rash onset, or at any time if new vesicles forming or cutaneous/motor/neurologic/ocular complications.

Varicella zoster

Mild

Moderate-severe/Disseminated