ABSTRACT
Herpes zoster represents the reactivation of latent chickenpox. After the patient recovers from varicella, the virus persists in a latent form within the peripheral nervous system. The triggering mechanism for reactivation of viral synthesis is poorly understood, but may be related to diminishing specific immunity with age. Its clinical manifestation is shingles, in which the cutaneous lesions, rather than being generalized, are restricted to one to three dermatomes. Because of the sensorineural ganglion involvement, intense pain is characteristic of this manifestation of the VZV. Pain precedes lesion formation by two to three days and may confuse the initial diagnosis until lesions develop. The vesicular rash develops over three to five days, with the total duration of herpes zoster lasting up to 15 days. The trunk is the major area of disease involvement. Less frequently involved are the head, limbs, and genital area. Patients older than 50 years have as great as 50% risk of developing postherpetic neuralgia.
