Diagnosis and Management of Herpes Zoster

Abstract

Herpes zoster is a neurocutaneous disease caused by the varicella-zoster virus (VZV). Primary exposure to the varicella-zoster virus will manifest as varicella or chickenpox and undergo reactivation causing shingles otherwise known as herpes zoster. Transmission of herpes zoster is via the respiratory route and infects epithelial cells in the upper respiratory tract. The risk of contracting herpes zoster is estimated at 15-30%, but the risk is higher in adults and the elderly, immunocompromised patients, and patients with comorbidities. The peak incidence of herpes zoster in Indonesia occurs in the age range of 45-64 years. Herpes zoster infection usually begins with prodromal symptoms such as malaise, headache, fever, localized myalgia, arthralgia, pruritus (itching sensation), and paresthesia (tingling) dermatomes that precede the rash within hours to days. The herpes zoster disease can reduce the effectiveness and quality of life of patients due to severe pain caused during the prodromal phase, and after the lesion, heal can cause postherpetic neuralgia (PHN). Establishing an early diagnosis combined with effective treatment serves to treat acute conditions, inhibit disease progression, reduce pain due to skin lesions, and prevent complications due to chronic conditions. The diagnosis of herpes zoster will be very clear because the clinical picture is typical. Herpes zoster is generally diagnosed clinically after the appearance of the rash. However, before the rash develops and in atypical cases, the diagnosis may require laboratory confirmation. This article will discuss information about etiology, pathophysiology, diagnosis, and management that can be done in cases of herpes zoster.