Dermatology/ Herpes Zoster

Question 1

Herpes zoster, or shingles, is a reactivated form of what virus from the sensory ganglia?

Answer 1

Varicella-zoster virus

Question 2

What does herpes zoster look like?

Answer 2

Grouped clear vesicles on an erythematous base in a dermatomal distribution

Question 3

Where does herpes zoster most commonly occur?

Answer 3

The trunk

Question 4

What are risk factors for herpes zoster?

Answer 4

• History of varicella
• age >50 years
• immunocompromise

Question 5

How does herpes zoster present in the prodromal, acute, and chronic stages?

Answer 5

Prodromal (2-3 weeks): stabbing/pricking pain in the involved dermatome

Acute (3-7 days): new crops of lesions from papules → vesicles → pustules → crusts

Chronic (months-years): post-herpetic neuralgia usually resolves within 12 months

Question 6

What percentage of patients with herpes zoster will develop post-herpetic neuralgia (PHN)?

Answer 6

10%-15%. Incidence increases with age.

Question 7

How can the diagnosis of herpes zoster be confirmed?

Answer 7

• Tzanck smear
• viral culture or
• direct fluorescent antibody test

Question 8

What is a Tzanck smear?

Answer 8

Scrape the base of a fresh blister and then spread on a glass slide stained with Giemsa or Wright stain to look for typical multinucleated giant cells

Question 9

Can herpes zoster be spread?

Answer 9

You cannot give someone zoster, but you can transmit primary varicella from an active cutaneous lesion to a susceptible individual.

Question 10

What is the treatment of herpes zoster?

Answer 10

• Acyclovir initiated within 72 hours after acute vesiculation
• pain control with analgesics, gabapentin, or tricyclic antidepressants