Shingles (herpes zoster) You are Here: Home Page > Communicable Disease > Shingles (herpes zoster) Shingles (herpes zoster) Herpes zóster - Medline Plus Información de Salud para Usted What is shingles? Shingles, also called herpes zoster or zoster, is a painful skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains inactive in the body. Usually the virus does not cause any further problems; however, the virus may re-emerge years later, causing shingles. Who gets shingles? Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.

How is shingles spread? A person must have already had chickenpox in the past to develop shingles. A person can not get shingles from a person that has it. However, the virus that causes chickenpox and shingles can be spread from a person with active shingles to a person who has never had chickenpox or been vaccinated through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or if pain persists after the rash is gone (post-herpetic neuralgia). What are the symptoms of shingles? Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after three to five days. The rash usually clears within two to four weeks. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop.

Other symptoms of shingles can include fever, headache, chills, and upset stomach. How soon do symptoms appear? The virus lies dormant in someone who has had chickenpox in the past. It can reactivate many years later. What are the complications associated with shingles? Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about one person in five, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe. Is there a treatment for shingles? Several medicines, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are available to treat shingles.

These medications should be started as soon as possible after the rash appears and will help shorten the illness and decrease how severe the illness is. Pain medicine may also help with pain caused by shingles. Call your provider as soon as possible to discuss treatment options. Does past infection make a person immune? Usually. Most people who have shingles have only one episode with the disease in their lifetime. Although rare, a second or even third case of shingles can occur. Is there a vaccine for shingles? Yes. A single dose of herpes zoster vaccine called Zostavax is recommended for adults 60 years of age and older whether or not they report a prior episode of shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain that persists after the rash resolves) once it develops. What can be done to prevent the spread of shingles? Chickenpox must be prevented in order to prevent shingles. A vaccine for chickenpox is now available and it is hoped that immunized individuals will be less likely to develop shingles in later life. The risk of spreading shingles is low if the rash is covered.

People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious. Revised: January 2014 Shingles | Clinical Overview - Varicella Vaccine | Herpes Zoster | CDC Clinical Overview Learn why the increases in shingles rates among adults are unlikely to be related to childhood chickenpox vaccination. Released 4/14/2014 Herpes Zoster in People Who Received Varicella Vaccine Herpes zoster, also known as zoster and shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella (chickenpox). Primary infection with VZV causes varicella. Once the illness resolves, the virus remains dormant (latent) in the dorsal root ganglia. VZV can reactive later in a person’s life and cause a painful, maculopapular rash called herpes zoster. Anyone who has had varicella or gotten varicella vaccine can develop herpes zoster. Most people typically have only one episode of herpes zoster in their lifetime.

However, second and even third episodes are possible. Clinical Features People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. The rash does not usually cross the body’s midline. However, approximately 20% of people have rash that overlaps adjacent dermatomes. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster. This generally occurs only in people with compromised or suppressed immune systems. Disseminated zoster can be difficult to distinguish from varicella. The rash is usually painful, itchy or tingly. These symptoms may precede rash onset by days to weeks. Some people may also have headache, photophobia (sensitivity to bright light), and malaise in the prodromal phase. The rash develops into clusters of clear vesicles. New vesicles continue to form over three to five days and progressively dry and crust over. They usually heal in two to four weeks. There may be permanent pigmentation changes and scarring on the skin. Complications Postherpetic neuralgia (PHN) is the most common complication of herpes zoster.

It is a persistent pain in the area where the rash once was. PHN is diagnosed in people who have pain that persists after their rash has resolved. Some define PHN as any duration of pain after the rash resolves; others define it as duration of pain for more than 30 days, or for more than 90 days after rash onset. PHN can last for weeks or months and occasionally, for many years. A person's risk of having PHN after herpes zoster increases with age. Older adults are more likely to have PHN and to have longer lasting and more severe pain. Approximately 13% (and possibly more) of people 60 years of age and older with herpes zoster will get PHN. PHN is rare in people younger than 40 years old. Other predictors of PHN include the level of pain a person has when they have the rash and the size of their rash.

Other complications of herpes zoster include— ophthalmic involvement with acute or chronic ocular sequelae (herpes zoster ophthalmicus); bacterial superinfection of the lesions, usually due to Staphylococcus aureus and, less commonly, due to group A beta hemolytic streptococcus; cranial and peripheral nerve palsies; and visceral involvement, such as meningoencephalitis, pneumonitis, hepatitis, and acute retinal necrosis. People with compromised or suppressed immune systems are more likely to have complications from herpes zoster. They are more likely to have severe rash that lasts longer. Also, they are at increased risk of developing disseminated herpes zoster. Top of Page Vaccination The Advisory Committee on Immunization Practices (ACIP) recommends zoster vaccine (Zostavax®) for people aged 60 years and older. Even people who have had herpes zoster should receive the vaccine to help prevent future occurrences of the disease. Herpes zoster vaccine is approved by FDA for people aged 50 years and older. However, CDC does not recommend routine use of herpes zoster vaccine in people aged 50 through 59 years old.

Health care providers considering the herpes zoster vaccine for certain persons aged 50 through 59 years should discuss the risks and benefits of vaccination with their patients. Although the vaccine has short-term efficacy, there have been no long-term studies of vaccine protection in this age group. In adults vaccinated at age 60 years or older, vaccine efficacy wanes within the first 5 years after vaccination, and protection beyond 5 years is uncertain; therefore, adults receiving the vaccine before age 60 years might not be protected when their risks for herpes zoster and its complications are highest. Transmission People with active lesions caused by herpes zoster can spread VZV to susceptible people . People who have not had varicella and never received chickenpox vaccine can get infected with VZV from someone with herpes zoster. If this happens, they are at risk of developing varicella not herpes zoster. The virus spreads when a person has direct contact with the active herpes zoster lesions. The lesions are infectious until they dry and crust over. People with active herpes zoster lesions should avoid contact with susceptible people in their household and in occupational settings until their lesions dry and crusted.

Epidemiology Risk Factors Only people who had natural infection with wild-type VZV or had varicella vaccination can develop herpes zoster. Children who get the varicella vaccine appear to have a lower risk of herpes zoster compared with people who were infected with wild-type VZV. Many people do not remember having varicella; however, approximately 99.5% of people born in the United States who are 40 years of age and older have been infected with wild-type VZV. As a result, all older adults in the United States are at risk for herpes zoster. The reasons why VZV reactivates and causes herpes zoster are not well understood. However, a person's risk for herpes zoster may increase as their VZV-specific cell-mediated immunity declines. This decline in immunity can result from increasing age and/or medical conditions and medications that suppress the immune system. A person's risk for herpes zoster increases sharply after 50 years of age. Almost 1 out of 3 people in the United States will develop herpes zoster during their lifetime. A person’s risk of developing PHN also increases sharply with age.

The risk of complications of herpes zoster, including PHN and hospitalization, also increases with age. People with compromised or suppressed immune systems who have an increased risk for herpes zoster include those with cancer, especially leukemia and lymphoma, with human immunodeficiency virus, who have undergone bone marrow or solid organ (renal, cardiac, liver, and lung) transplantation, or who are taking immunosuppressive medications, including steroids, chemotherapy, or transplant-related immunosuppressive medications. Other potential risk factors for herpes zoster have been identified but the findings are not consistent in all studies. For example- Most, but not all, studies found that more women than men develop herpes zoster [ 1,2 ]; the reason for a possible difference between women and men is not known. Some studies conducted in the United States and elsewhere found that herpes zoster is less common in blacks (by at least 50%) than in whites.[ 3 ] Rates Disease occurrence: The incidence for herpes zoster is approximately 4 cases per 1,000 U.S. population annually, age-adjusted to the 2000 U.S.

population The incidence among people 60 years of age and older is about 10 cases per 1,000 U.S. population annually. There are an estimated one million cases of herpes zoster in the United States annually. Repeat episodes: Although 2nd and even 3rd episodes of herpes zoster can occur, the annual incidence of recurrence is not known. Hospitalizations: Approximately 1 to 4% of people with herpes zoster get hospitalized for complications. Older adults and people with compromised or suppressed immune systems are more likely to get hospitalized. About 30% of all people hospitalized with herpes zoster are those with compromised or suppressed immune systems. Deaths: A recent study estimated that there are 96 deaths each year in which herpes zoster was the actual underlying cause (0.28 to 0.69 per 1 million population). Almost all the deaths occurred in elderly people or those with compromised or suppressed immune systems. [ 4 ] Trends Herpes zoster rates are increasing among adults in the United States. The increase has been gradual over a long period of time.

We do not know the reason for this increase.[ 5,6,7 ] Some experts suggest that exposure to varicella boosts a person’s immunity to VZV and reduces the risk for VZV reactivation. Thus, they are concerned that routine childhood varicella vaccination, recommended in the United States in 1996, could lead to an increase in herpes zoster in adults due to reduced opportunities for being exposed to varicella. However, two CDC studies have found that herpes zoster rates: started increasing before varicella vaccine was introduced in the United States, and did not accelerate after the routine varicella vaccination program started.[ 5,8 ] Other countries, that do not have routine varicella vaccination programs, have also observed similar increases in herpes zoster rates.[ 9 ] Herpes Zoster in People Who Received Varicella Vaccine Although uncommon among children, the rate of herpes zoster in U.S. children has been declining since the routine varicella vaccination program started. Varicella vaccine contains live attenuated VZV, which causes latent infection.

The attenuated vaccine virus can reactivate and cause herpes zoster; however, children vaccinated against varicella appear to have a lower risk of herpes zoster than people who were infected with wild-type VZV. [10] The reason for this is that vaccinated children are less likely to become infected with wild-type VZV, and the risk of reactivation of vaccine-strain VZV is lower compared with reactivation of wild-type VZV. In a study of children with leukemia, those who got varicella vaccine had a 67% lower risk of herpes zoster compared with children who had natural infection with wild-type VZV.[ 11 ] Data on healthy children show a similar pattern of reduced risk of herpes zoster in those vaccinated against varicella. The number of older adults who have gotten varicella vaccine since it was licensed in 1995 is quite small. There is very little information on the risk of herpes zoster in people who got varicella vaccine as adults. CDC continues to study the epidemiology of herpes zoster among adults and children and to monitor the effects of the U.S. varicella and zoster vaccination programs.

References Herpes Herpes Treatments What is herpes? Herpes is a term that generally refers to a family of viral infections characterized by painful, fluid-filled sores or blisters in and around the mouth or genital region. Herpes is also called herpes simplex, which includes two types: Genital herpes is a common sexually transmitted disease (STD) marked by outbreaks of blisters and lesions in the genital area. Genital herpes is most often caused by infection of the herpes simplex virus type 2 (HSV-2).About one out of six people 14 to 49 years of age has genital herpes caused by the HSV-2 infection, according to the Centers for Disease Control and Infection (Source: CDC ). Another herpes virus, herpes simplex virus type 1 (HSV-1), which generally causes oral herpes, can also cause genital herpes. Oral herpes (herpes simplex labialis) is a very common disease that causes small, painful cold sores and fever blisters of the mouth, lips or gums. Oral herpes is most often caused by HSV-1, but HSV-2 may also be responsible in some cases.

It is estimated that 50% to 80% of all American adults have oral herpes, according to the Centers for Disease Control and Infection. HSV-1 and HSV-2 are closely related viruses that belong to a larger family of herpes viruses that can cause a variety of other diseases. Other common types of herpes viruses include cytomegalovirus (CMV), herpes zoster (causes shingles and chickenpox), and Epstein-Barr virus (can cause mononucleosis and other infections). Looking for a Doctor? Search Now Find an Infectious Disease Specialist Herpes simplex virus infections are very contagious and can be spread to either the genital or oral areas by direct contact with herpes sores or blisters, or skin, saliva, or mucus membranes infected with a herpes simplex virus. Herpes is not curable, but it is preventable and controllable in many cases. Dangers of Mixing Alcohol and Hepatitis C In some cases, herpes can lead to serious complications, such as meningitis, blindness, or death of a newborn that was exposed to the disease during pregnancy or delivery.

Seek prompt medical care if you are pregnant or have a disease or condition that suppresses the immune system, and believe that you have been exposed to herpes or have herpes symptoms, such as sores or blisters in the genital or oral area. Shingles: Causes, Symptoms, and Treatments - Medical News Today Shingles: Causes, Symptoms, and Treatments Written by Hannah Nichols Reviewed by University of Illinois-Chicago, School of Medicine Shingles is an infection of an individual nerve and the skin surface that is supplied by the nerve; it is caused by the varicella-zoster virus - the same virus that causes chickenpox. Anyone who has recovered from chickenpox , child or adult, can get shingles. There are an estimated 1 million cases of shingles each year in the United States, with 1 in 3 people developing shingles during their lifetime. Contents of this article: Fast facts on shingles Here are some key points about shingles. More detail and supporting information is in the main article.

Each year in the U.S., there are an estimated 1 million cases of shingles Around 1 in 3 people will develop shingles during their lifetime Shingles is a painful infection of the nerve supplying an area of skin and is accompanied by a localized skin rash What is shingles? Varicella-zoster (shingles) virus belongs to a group of viruses called herpesviruses. Shingles is caused by the same virus that causes chickenpox. After recovery from chickenpox, the virus remains in the body and lies dormant in the central nervous system . Varicella-zoster virus belongs to a group of viruses called herpes viruses, which is why shingles is also known as herpes zoster. All herpes viruses can hide in the nervous system where they can remain almost indefinitely. Given the right conditions, the herpes zoster virus can "reactivate" (or wake up from hibernation) and travel down nerve fibers to cause a new active infection. The blistering skin rash associated with shingles usually appears in one or more distinct bands, called dermatomes. It may also appear on the face in a band, or break out on a quarter of the face.

These dermatomes correspond to a single sensory nerve, which is why infection causes isolated skin lesions rather than a body-wide rash and nerve pain. It is not possible to have shingles if you have never been exposed to chickenpox or the varicella virus that causes it. Once exposed, the virus can lay dormant for years. In fact, the inactive virus may never cause any problems. However, in some individuals, it may reactivate multiple times. Shingles is most common in people over the age of 50 ; about half of all cases occur in men and woman aged 60 or over. However, the virus may reappear in people of all ages who have previously had chickenpox. Most adults with the dormant virus never experience an outbreak of shingles. Causes of shingles In most shingles cases, there is no known reason why the varicella-zoster virus begins multiplying. One suggestion is that shingles occurs when something weakens the immune system, prompting the virus to reactivate.

Some possible triggers for shingles include: Aging Diseases - including certain cancers and HIV/ AIDS Cancer treatments - chemotherapy and radiation therapy lower resistance to disease Stress or trauma - psychological and emotional stressors Medications - immunosuppressive drugs; after a transplant, a high percentage of patients develop shingles Children - youngsters whose mothers had chickenpox late in pregnancy or had chickenpox in infancy themselves Symptoms of shingles Symptoms of shingles include pain, tender skin, and a rash, usually on one side of the body. The most common symptom of shingles is pain - a constant dull, burning, or gnawing pain, or sharp, stabbing pains that come and go. Other common symptoms include tender skin and a blistering rash. Typically, shingles takes the following course: Acute pain, tingling, numbness, and itching on a specific part of the skin, on a single side of the body. 1-5 days after the pain begins, a rash appears. Red blotches emerge that develop into itchy fluid-filled blisters. The rash looks like chickenpox but only on the band of skin supplied by the affected nerve. The rash may involve the face, eyes, mouth, and ears in some cases.

Sometimes the blisters merge, forming a solid red band that looks like a severe burn. In rare cases (among people with weakened immune systems) the rash may be more extensive and look similar to a chickenpox rash. Shingles can affect the eye, called optical shingles. The virus invades an ophthalmic nerve and causes painful eye inflammation and temporary or permanent loss of vision. New blisters may arise for up to a week. Inflammation might be caused in the soft tissue under and around the rash. People with lesions on the torso may feel spasms of pain at the gentlest touch. The blisters will gradually dry up and form scabs or crusts, in 7-10 days. At this point, the rash is no longer considered infectious. Minor scarring may occur where the blisters have been. A shingles episode normally lasts 2-4 weeks. In some cases, there is a rash but no pain; or, no visible rash but a band of pain.

Other symptoms of shingles can include: Varicella-zoster virus | University of Maryland Medical Center Introduction The varicella-zoster virus (VZV) can cause two diseases: chickenpox (varicella) and shingles (herpes zoster). Before a vaccine was developed in 1994, chickenpox was a common contagious childhood disease that produced itchy blisters, but rarely caused serious problems. However, if adults who did not have the disease as children contract it, it could cause more serious complications. Shingles is caused by the same virus that causes chickenpox. Once you have had chickenpox, the varicella-zoster virus lies dormant in your nerves and can re-emerge as shingles. Shingles, which is characterized by a rash of blisters, can be very painful. But it is not life threatening. Some people who develop shingles also develop a condition caused postherpetic neuralgia, which causes the skin to remain painful even after the rash is gone. Shingles is most common in people over age 60, or in those with weakened immune systems. There is a vaccine that reduces your risk of getting shingles.

Signs and Symptoms Chickenpox The typical rash of chickenpox is made up of groups of small, itchy blisters surrounded by inflamed skin. The rash usually starts on the face, scalp, or chest, and quickly spreads throughout the body. It usually appears a few days after you have been exposed. Over 4 days, each blister tends to dry out and form a scab, which then falls off 9 to 13 days later. The rash may be preceded or accompanied by: Fever, usually low grade Flu-like symptoms Shingles The typical shingles rash starts as redness followed by blisters that usually cover only one side of your body. The rash follows the path of the nerve where the virus has lain dormant. About 50 to 60% of people with shingles have the rash on their trunk. The next most common site is one side of the face, which may even include the tongue, eye, or ear. Before the rash appears, you will have warning symptoms of pain, usually a sharp, aching, piercing, tearing, or burning sensation, on the part of your body where the rash appears 1 to 5 days later.

That area may also feel itchy, numb, and unbearably sensitive to touch, even just from your clothes touching your skin. Other symptoms may include: Causes Chickenpox Both chickenpox and shingles are caused by the varicella-zoster virus (VZV), a type of herpes virus. The virus is spread when you come into contact with the rash, or by sneezing, coughing, and breathing. In other words, when someone with chickenpox sneezes or coughs, there are droplets with the VZV virus in the air. The person is contagious from 2 days before the rash appears until all of the blisters have crusted over. Shingles While shingles is caused by the same virus that leads to chickenpox, the way you develop this painful skin condition is different. After you have had chickenpox, the virus lives in a dormant state, as if it is hibernating, in nerve cells along your spine. Later in life, when it "wakes up", usually from a weakened immune system, aging, or other risk factor, the virus travels down the path of the particular nerve where it was "hibernating," causing pain followed by the rash.

About 30% of people who have had chickenpox will develop shingles. Getting vaccinated can reduce your risk. Risk Factors Exposure to the virus if you have not had chickenpox nor received the vaccine Being under 10 years of age Time of year: late winter and early spring is the most common time that the virus is spread Shingles Age (most common in people over 60) Stress Weakened immune system (for example, people with HIV/AIDS, or those taking drugs to suppress the immune system due to autoimmune diseases or organ transplants) Having had chickenpox before age 1 Diagnosis Your doctor can usually diagnose chickenpox easily because of its characteristic rash. However, if there is any doubt, the doctor may view a scraping from one of the blisters under the microscope. If you have shingles, your doctor can usually make a diagnosis from the history of pain and other symptoms and the rash itself. He or she may take a scraping from one of the blisters for a laboratory test. Preventive Care Chickenpox The chickenpox vaccine (Varivax) is given to children over 1 year old.

If a person receives the vaccine before age 13, then he or she only needs one dose. If a person receives the vaccine when he or she is older than 13, a second dose is needed 1 to 2 months later. If you have never had chickenpox or the vaccine, avoid contact with anyone who has chickenpox. Children with chickenpox should be kept out of school or daycare until their doctor says otherwise to avoid spreading the virus. Shingles If you have never had chickenpox, the chickenpox vaccine can reduce your risk of getting chickenpox and shingles. Even if you do get the disease, having had the vaccine reduces the risk of complications. The shingles vaccine (Zostavax) can reduce the risk of getting shingles among people who are over 60 and have had chickenpox. It does not completely ensure you will not get shingles. If you do develop shingles, being vaccinated reduces the severity and the risk of postherpetic neuralgia.

The shingles vaccine is not recommended for people who: Have ever had a reaction to gelatin or neomycin Have a weakened immune system Take drugs to suppress the immune system (such as corticosteroids) Have tuberculosis Have a history of lymphatic or bone marrow cancer One study found that older adults who regularly practice tai chi had a better immune response to the varicella virus, and their immunity increased even more when they had the shingles vaccine. Treatment Approach Both chickenpox and shingles generally get better by themselves, unless you are at high risk for complications. The goal of treatment is to reduce pain and itching. Lifestyle You can reduce symptoms of chickenpox and shingles with some simple steps: Apply cool water compresses to your skin or soak in a bathtub filled with cool water Add finely ground oatmeal (there are special brands sold in drugstores) to the bathtub Apply calamine or an over-the-counter hydrocortisone lotion to the affected areas Trim your fingernails to avoid infection For small children with chickenpox, cover hands with loose fitting, soft cotton or flannel mittens to prevent scratching Medications Chickenpox Antihistamine.

If itching is severe, your doctor may suggest an antihistamine (such as Benadryl). Acyclovir (Zovirax). An antiviral drug prescribed for children who are at high risk of complications from chickenpox, or for adults who have chickenpox. Pain relievers. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help reduce pain. DO NOT give aspirin to children under 19 because of the risk of a rare but serious illness called Reye syndrome. Shingles Antiviral drugs. Most effective when started within 72 hours of the first sign of a rash, these drugs are often given to people who are at risk of postherpetic neuralgia. They include: Acyclovir (Zovirax) Valacyclovir (Valtrex) Corticosteroids. Used with Zovirax to reduce inflammation. Pain relievers. For pain associated with shingles, an over-the-counter pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be effective.

For severe pain, or pain associated with postherpetic neuralgia, your doctor may prescribe a narcotic (opioid) pain reliever. For postherpetic neuralgia Capsaicin. Contains a pain reliever derived from chili peppers that produces a burning sensation when applied to the skin. It is available as an ointment (Zostrix) or a patch. A 2003 study reported that the patch reduced pain by 33% in about half of people with postherpetic neuralgia. Lidocaine patch (Lidoderm). Applied to the skin to reduce pain. Tricyclic antidepressants. Low doses of tricyclics, especially nortiptyline (Pamelor), may help reduce pain. Gabapentin (Neurontin). An anticonvulsant (antiseizure) medication that may also help reduce pain. Nutrition and Dietary Supplements Since supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Adenosine monophosphate (AMP).

An early study looked at injections of AMP, a compound that is made by the body, for treating the initial symptoms of shingles, as well as preventing postherpetic neuralgia. Researches gave people with shingles injections of either 100 mg of AMP or placebo. At the end of 4 weeks, 88% of those who got AMP were pain free compared to 43% who got placebo. The study used injections of AMP, so researchers do not know if taking AMP orally would have any effect. People who take dipyridamole (Persatine) or carbamazepine (Tegretol) should not take AMP. People with heart disease or gout should not take AMP. Vitamins B-12 and E. A few studies suggest that vitamin E (1,200 to 1,600 mg per day) and injections of B-12 (but not oral B-12) might help reduce symptoms of postherpetic neuralgia. But the studies were not good quality, and more research is needed. Herbs The use of herbs is a time-honored approach to strengthening the body and treating disease.

However, herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. Cayenne (Capsicum frutescens/Capsicum spp.). Capsaicin cream made from cayenne pepper can relieve pain when applied to the skin. Capsaicin may help relieve the pain of post herpetic neuralgia, and an over-the-counter ointment is approved for this treatment (see Medications). Capsaicin causes burning when applied to the skin, so use sparingly and do not use around eyes, nose, or mouth. German Chamomile (Matricaria recutita). Traditionally, this herb has been used topically to treat skin conditions and childhood illnesses like chickenpox. However, no scientific studies have examined whether chamomile is helpful in treating chickenpox. Chamomile interacts with a number of medications, so ask your doctor before taking it. People who are allergic to ragweed, chrysanthemums, daisies, and other members of the aster family, should not take chamomile. Licorice (Glycyrrhiza glabra).

Traditionally, licorice gel has been used topically (applied to the skin) to treat shingles and postherpetic neuralgia. In test tubes, one of the constituents of licorice, called glycyrrhizin, stops the varicella zoster virus from reproducing. However, no scientific studies have examined whether licorice gel is helpful in treating either shingles or postherpetic neuralgia. Licorice, if absorbed systemically, interacts with a number of medications, and can potentially aggravate certain medical conditions, such as hypertension. Ask your doctor before using it. Acupuncture Although the results of scientific studies have been mixed, acupuncture may help relieve the nerve pain associated with shingles, especially when combined with traditional medications. Acupuncturists treat people based on an individualized assessment of the excesses and deficiencies of qi (or energy) located in various meridians. In the case of shingles, a qi deficiency is usually detected in the liver meridian and an excess in the gallbladder meridian. Acupuncturists will often provide needle or moxibustion treatment (a technique in which the herb mugwort is burned over specific acupuncture points) around painful areas.

Homeopathy Few studies have examined the effectiveness of specific homeopathic therapies, however, professional homeopaths may consider the following remedies for the treatment of chickenpox and shingles based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. Your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Chickenpox: Antimonium crudum. For irritable children who are extremely sensitive to touch and may have a thick white coating on the tongue. Antimonium tartaricum. For large, slowly-appearing pox lesions accompanied by cough. Mercurius. For large, pus-filled pox which may ooze; this remedy is most appropriate for individuals who sweat profusely and may have enlarged lymph nodes. Pulsatilla. For fever associated with chicken pox; children who tend to be whiny, clingy, and weepy but have little thirst despite the fever. Rhus toxicodendron. For severe itching that worsens at night and improves with warm compresses or a bath; this remedy is the most commonly prescribed. Sulphur.

For extremely itchy lesions that worsen with heat or bathing, and which children will often scratch to the point of bleeding. Shingles: Arsenicum. For intense burning sensation that improves with warmth and worsens with cold. Lachesis. For particularly dark, sometimes purple, lesions on the left side of the body. Mezereum. For burning, sharp pains that worsen with touch; this remedy is most appropriate for individuals who are naturally chilly and sensitive to cold. Ranunculus bolbosus. For lesions located on the chest or back; pain worsens with touch and movement. Rhus toxicodendron. For intense itching and pain that may be relieved by touch. Mind-Body Medicine The following relaxation techniques may help reduce the pain and stress associated with shingles and postherpetic neuralgia: Meditation People with post herpetic neuralgia have reported some relief from using hypnosis. Other Considerations If you get chickenpox when you are pregnant, the infection may spread to the baby. Special Populations If you have a weakened immune system, shingles blisters may spread to other parts of your body and it will likely take longer for the symptoms to heal, maybe lasting for months.

Conditions that weaken your immune function include: HIV or AIDS Cancer, especially leukemia, Hodgkin's disease and other lymphomas, or undergoing chemotherapy Having an autoimmune disease (such as rheumatoid arthritis, lupus, multiple sclerosis, and Crohn's disease) Taking drugs that suppress your immune system Warnings and Precautions Do not give aspirin to children under 19 due to the risk of a rare but serious illness called Reye's syndrome. Call your doctor if you experience confusion, vomiting, or weakness, even paralysis, of the arms, legs, trunk, or face during or soon after a chickenpox or shingles infection. Prognosis and Complications While chickenpox usually goes away on its own, severe and sometimes fatal infections may occur, particularly in newborn infants, adults, and people whose immune systems are weakened. Potential infections include: Encephalitis, a brain infection Myocarditis, an infection of the heart muscle Pneumonia Secondary bacterial skin infection Shingles usually clears up in 2 - 3 weeks. Your chance of getting another bout of shingles is only 1 - 5% if you have a healthy immune system.

If you have a weakened immune system (see Special Populations), your risk for recurrence is higher. Potential complications from shingles include: Shingles lesions involving the mouth or eye; the latter may lead to blindness if not treated. Postherpetic neuralgia, persistent pain for months to years even after the skin lesions have cleared up. Secondary bacterial skin infections. Encephalitis (a brain infection) or sepsis (an infection in your blood stream, affecting many organs in the body). A growing body of research suggests that VZV may lead to a variety of neurologic complications, including encephalitis and meningitis. Supporting Research Arvin A. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012. Betts RF. Vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S143-S147. Black: Obstetric and Gynecologic Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2008. Cohen J.

Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011. Davies SJ, Harding LM, Baranowski AP. A novel treatment of postherpetic neuralgia using peppermint oil. Clin J Pain. 2002;18(3):200-2. Frisch S, Guo A. Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster. Clinics in Geriatric Medicine. Philadelphia, PA: W.B. Saunders Company. 2013;29(2). Gould D. Varicella zoster virus: chickenpox and shingles. Nurs Stand. 2014;28(33):52-8. Hu J. Acupuncture treatment of herpes zoster. J Tradit Chin Med. 2001;21(1):78-80. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc.

2007 Apr;55(4):511-7. Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother. 2004 Mar;5(3):551-9. Review. Lamont RF, Sobel JD, Carrington D, et al. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG. 2011;118(10):1155-62. Nagel MA. Varicella zoster virus vasculopathy: clinical features and pathogenesis. J Neurovirol. 2014;20(2):157-63. Nagel MA, Gilden D. Neurological complications of varicella zoster virus reactivation. Curr Opin Neurol. 2014;27(3):356-60. Niv D, Maltsman-Tseikhin A. Postherpetic neuralgia: the never-ending challenge. Pain Pract. 2005 Dec;5(4):327-40.

Pieroni A. Medicinal plants and food medicines in the folk traditions of the upper Lucca Province, Italy. J Etnopharmacol. 2000;70(3):235-73. Powell DR, Patel S, Franco-Paredes C. Varicella-Zoster Virus Vasculopathy: The Growing Association Between Herpes Zoster and Strokes. Am J Med Sci. 2015;350(3):243-5. Reilly MP. Clinical applications of acupuncture in anesthesia practice. CRNA. 2000;11(4):173-9. Roxas M. Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations. Altern Med Rev. 2006 Jun;11(2):102-13. Review. Silver B, Zhu H. Varicella zoster virus vaccines: potential complications and possible improvements. Virol Sin. 2014;29(5):265-73. Stankus SJ, Dlugopolski M, Packer D.

Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61(8):2437-8. Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S136-S142. Review. Wu J, Guo Z. Twenty-three cases of postherpetic neuralgia treated by acupuncture. J Tradit Chin Med. 2000;20(1):36-37. Young MK, Wood M, Jean-Noel N. Postherpetic neuralgia in older adults: culture, quality of life, and the use of alternative/complementary therapies. Holist Nurs Pract. 2007 May-Jun;21(3):124-34. Review.

Alternative Names Herpes zoster | definition of herpes zoster by Medical dictionary Herpes zoster | definition of herpes zoster by Medical dictionary Related to herpes zoster: herpes simplex herpes [her´pēz] any inflammatory skin disease caused by a herpesvirus and characterized by formation of small vesicles in clusters. When used alone the term may refer to either herpes simplex or herpes zoster . herpes cor´neae herpetic inflammation involving the cornea. herpes febri´lis a variety of herpes simplex usually found on or around the lips and nostrils but occasionally on other mucoid tissues. It is generally caused by human herpesvirus 1, although occasionally it may be caused by human herpesvirus 2. It is usually a concomitant of fever, but may also develop in situations of other stresses without fever or prior illness. The virus is carried by most people but usually lies quiescent. There is no cure for the condition, but some medications increase comfort. Antiviral medications used in this way include acyclovir and valacyclovir . Called also fever blisters and cold sores.

genital herpes (herpes genita´lis) herpes simplex of the genitals, a common sexually transmitted disease , usually caused by human herpesvirus 2 but occasionally by human herpesvirus 1. If it is present at term in the pregnant female, it may lead to infection of the neonate (see maternal herpes ). The incidence of active genital herpes is difficult to determine precisely because many cases present mild symptoms, are self-limiting, and are not called to the attention of health care personnel. However, it is clear that the disease has reached epidemic proportions in the United States. It is highly contagious and is transmitted by direct person-to-person contact (not limited to sexual contact). Autoinoculation via the hands is possible; for example, from a lip ulcer to the genital area or from the lip or genitals to the eye. Once the virus gains access to the body it enters the nervous system and invades nerve cells located near the site of infection, such as in the sacral ganglia. The virus lies dormant in nerve cells and can remain there indefinitely, predisposing the person to recurrent outbreaks. Factors contributing to recurrent genital herpes are not well understood. Some infected persons experience no recurrences while others have frequent and severe outbreaks.

Many patients are aware of a correlation between the appearance of lesions and precipitating factors such as exposure to sunlight, local trauma, fever, or emotional stress. Hormonal changes preceding menses have been associated with recurrences in women. Diagnosis and Symptomatology. Diagnosis is most often based on the patient's history and symptoms, which are easily recognized by an experienced clinician. Clinical and serological findings help establish whether the patient's complaints are manifestations of a primary infection or an initial phase of a recurrent episode. At the primary or first exposure to the virus, the typical cutaneous lesions may or may not be present and no antibodies to the virus are found in the patient's serum. The presence of such antibodies at the time of an initial episode indicates a previous herpes infection. Since the virus dwells in the lesions and nerve cells and not in the blood, antibody titers, smears, and cultures taken from the lesions can be helpful in identifying the stage of the disease. Typically, recurrent episodes become milder and less frequent; however, some patients may experience weekly or monthly outbreaks that are severe and painful. Those with recurrent herpes usually have high antibody titers.

Paradoxically, it has been noted that the higher the antibody titer the more severe the symptoms and the more frequent the recurrences. Thus, it is apparent that the body's immune system is not effective in providing protection against herpes infection or in mitigating its effects. A genital rash and mild itching usually are the earliest signs of infection. Eventually vesicles on the surface of the skin form, and then enlarge, break open, and ulcerate. The lesions are painful, especially during coitus, and can cause intense itching, and, if the urethra is involved, painful urination. The disease affects both sexes. In the male, vesicles are found principally on the glans penis, shaft of the penis, and prepuce, and may extend to the scrotum and inner thighs. In the female, vesicular eruptions usually involve the vulva, vagina, and cervix, and may extend to the perineum, inner thighs, and buttocks. Lesions of the cervix can vary from small superficial ulcers with diffuse inflammation to a single, large, necrotic ulcer. Other symptoms include malaise, fever, and anorexia. There also can be involvement of neural structures and the manifestation of neurologic symptoms.

The characteristic lesions usually last from one to three weeks in either the initial stage or during periodic outbreaks. Treatment. At the present time there is no cure for genital herpes. (A vaccine to prevent the development of herpes is under active development.) Antivirals such as acyclovir and valacyclovir help shorten episodes during the initial phase of infection, but do not cure it. Palliative treatment consists of measures to keep lesions clean and dry, to control pain with an analgesic, to promote healing with frequent sitz baths, and to prevent secondary bacterial infections. Complications and Sequelae. A primary herpetic infection usually is self-limiting, and, barring secondary infection and neurologic damage, immediate complications are rare. In some instances the infection may be complicated by urethral stricture, meningoencephalitis , labial fusion, or lymphatic suppuration. Although there is no conclusive evidence that herpesvirus infection actually leads to cervical cancer, women with genital herpes are eight times more likely to develop carcinoma in situ than are those whose serum lacks antibodies to the virus. Patient Care.

Probably the greatest needs of patients with herpes are accurate information and support and counseling to help them cope with the emotional impact and fears about the disease and its effects. The palliative treatments presented above can provide symptomatic relief. In addition, the patient should be told to try to keep the lesions clean and dry. Loose cotton clothing avoids trapping moisture in the genital area. The person should not use perfumed soaps or sprays, and women should not use feminine deodorants or douches. Management of stress can be important in controlling symptoms; ineffective or harmful coping mechanisms can aggravate the condition and delay healing. The emotional impact of genital herpes often is overwhelming to persons who learn they have the disease. Since there currently is no cure, preventive medication, or vaccine and the infection can be transmitted by intimate contact, patients often feel anger, guilt, fear, or anxiety. Support groups can provide patients opportunities to ventilate their anger and talk about their guilt. In a group of persons with similar problems, they can learn that there are others who have had much the same feelings and have managed to work through them and develop a more positive attitude. The American Social Health Association (ASHA) sponsors self-help groups and provides educational materials; their address is P.O.

Box 13827, Research Triangle Park, NC 27709. Fear of cancer is very real in these patients; females are encouraged to have a Pap smear every six months. Early detection is almost guaranteed with such frequent examinations, and the cure rate in these cases is 100 per cent. Another source of anxiety for female patients is the effect of herpes on fertility and the welfare of infants born of mothers with herpes (see maternal herpes ). herpes labia´lis herpes febrilis affecting the vermilion boder of the lips. maternal herpes active genital herpes during pregnancy and the perinatal period. Herpes infection during early pregnancy can result in a viral septicemia and spontaneous abortion . Infants born of mothers with active herpes during which there is shedding of the virus at the time of delivery are likely to become infected during a vaginal delivery. Of those who contract herpes from their mothers, about 50 per cent will not survive. Of the ones who do survive, half will suffer from permanent neurological or visual damage. Protective measures such as cesarean section for delivery improve the chances of avoiding infection in the newborn.

During the last trimester it is best if the woman abstains from sexual intercourse if there is any history of either partner having herpes. When there is such a history, it is recommended that frequent cervical viral cultures be done to determine whether vaginal delivery is safe. With early diagnosis and cesarean section many infants can be protected from infection, but only if the membranes are intact or have been ruptured no more than 4 to 6 hours before the operation. After that length of time it is assumed that an ascending infection has reached the fetus. Mothers who have no active lesions at the time of birth and two negative cervical smears for the virus within a week of delivery can safely deliver their newborns vaginally. Wound and skin precautions are followed in the care of the mother if she has recurrent herpes (see above). An isolation nursery and wound/skin precautions are recommended for newborns delivered (whether vaginally or by cesarean section) to women with active genital herpes. Some authorities recommend isolation precautions the entire time the newborn is in the hospital and until the incubation period of 21 days has passed. progenital herpes (herpes progenita´lis) herpes genitalis .

herpes sim´plex an acute viral disease caused by a herpesvirus and marked by groups of vesicles on the skin, each about 3 to 6 mm in diameter. Type 1 herpes simplex, or herpes labialis , is usually found on the borders of the lips or nostrils and has been nicknamed “kissing herpes.” It may accompany fever ( herpes febrilis or fever blisters), although there may also be other precipitating factors, such as the common cold, sunburn, skin abrasions, and emotional disturbances. Type 2 herpes simplex, or genital herpes , is usually found on or around the genital area. Infection of the newborn from a mother with the condition (see maternal herpes ) has a fatality rate of 50 per cent and many survivors have significant neurological or ocular sequelae. traumatic herpes (wrestler's herpes) a self-limiting cutaneous herpesvirus infection following trauma, the virus entering through burns or other wounds; the temperature rises moderately, and vesicles appear around the wound.

herpes zos´ter an acute viral disease caused by a herpesvirus (the same virus that causes chickenpox ); characteristics include inflammation of spinal ganglia and a vesicular eruption along the area of distribution of a sensory nerve. Called also shingles and zoster . It may appear in persons who have been exposed to chickenpox, and it sometimes accompanies other diseases such as pneumonia, tuberculosis, and lymphoma or is triggered by trauma or injection of certain drugs. In some cases it appears without any apparent reason for activation. Treatment is symptomatic and is aimed at relieving the pain and itching of the blisters. Local applications of calamine lotion or other lotions to dry the blisters may help. Herpes zoster is a very exhausting disease, especially for elderly people, because the constant itching and pain are difficult to control, even with systemic analgesics in some cases. Herpes zoster affecting the eye causes severe conjunctivitis and possible ulceration and scarring of the cornea if not treated successfully. Herpes zoster is a communicable disease and therefore requires some type of isolation, the specific precautions depending on whether the disease is localized or disseminated and also on the condition of the patient.

Localized lesions in immunocompromised patients often become disseminated. Persons susceptible to varicella-zoster (chickenpox) should stay out of the patient's room. This includes hospital personnel as well as other patients. If there is any question as to the proper procedures for prevention of the spread of herpes zoster, the CDC Guidelines for Infection Control in Hospital Personnel should be consulted. herpes zos´ter auricula´ris (herpes zos´ter o´ticus) Ramsay Hunt syndrome . her·pes zos·'ter an infection caused by a herpesvirus (varicella-zoster virus), characterized by an eruption of groups of vesicles on one side of the body following the course of a nerve due to inflammation of ganglia and dorsal nerve roots resulting from activation of the virus, which in many instances has remained latent for years following a primary chickenpox infection; the condition is self-limited but may be accompanied by or followed by severe postherpetic pain. Shingles | Johns Hopkins Medicine Health Library Fever and/or chills Headache The symptoms of shingles may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis. How is shingles diagnosed?

Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox. Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs. The healthcare provider may also take skin scrapings for testing. How is shingles treated? Specific treatment for shingles will be determined by your healthcare provider based on: Your age, overall health, and medical history How long the shingles have been present (some medicines are not as effective if given more than 2 to 3 days after the rash has appeared) Extent of the condition Your tolerance for specific medicines, procedures, or therapies Expectations for the course of the condition Your opinion or preference There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage.

Other treatments may include: Creams or lotions to help relieve itching Cool compresses applied to affected skin areas Antiviral medicines (such as acyclovir, valacyclovir, and famciclovir) Steroids Anticonvulsants What are the complications of shingles? Symptoms of shingles usually don’t last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include: Postherpetic neuralgia (PHN). The most common complication of shingles is called postherpetic neuralgia (PHN). This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents. Bacterial infection.

A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness. Can shingles be prevented? There is a vaccine available to prevent shingles. The vaccine is called Zostavax. It’s advised for healthy adults 60 years of age and older, though there is some literature that supports starting the vaccine in patients 50 years of age and older. Talk with your healthcare provider about the most appropriate time for you to get vaccinated. The vaccine has been found to reduce the number of episodes of shingles and the incidence of PHN in older adults. When should I call my healthcare provider? To reduce the severity and shorten the length of the illness, treatment must be started as soon as possible. If you think you have shingles, call your healthcare provider as soon as possible. Key points about shingles Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin. Shingles is caused when the chickenpox virus is reactivated.

It is more common in people with weakened immune systems, and in people over the age of 50. Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters. The rash is typically affects just one area on one side of the body or face. Treatment that is started as soon as possible helps reduce the severity of the disease. Next steps Herpes Zoster - National Library of Medicine - PubMed Health Vaccines for preventing herpes zoster (shingles) in older adults There is a vaccine to prevent shingles. Our objective was to evaluate the effectiveness and safety of the vaccine to prevent shingles in healthy older people. Valacyclovir compared with acyclovir for the treatment of herpes zoster ophthalmicus in people with an otherwise normal immune system The aim of this Cochrane Review was to find out if valacyclovir performs better than acyclovir in the treatment of a painful itchy rash caused by the chickenpox virus (herpes zoster ophthalmicus). Cochrane researchers collected and analysed all relevant studies to answer this question and found one study.

[Evaluation of vaccine to prevent herpes zoster in adults: a systematic review of the literature] Bibliographic details: Ruiz-Aragon J, Garcia-Cenoz M, Marquez-Pelaez S, Navarro Palenzuela C. [Evaluation of vaccine to prevent herpes zoster in adults: a systematic review of the literature]. [Evaluacion de la vacuna para la prevencion del herpes zoster en adultos: revision sistematica de la literatura.] Vacunas 2014; 15(1-2): 13-20 Vaccines for preventing herpes zoster (shingles) in older adults There is a vaccine to prevent shingles. Our objective was to evaluate the effectiveness and safety of the vaccine to prevent shingles in healthy older people. Valacyclovir compared with acyclovir for the treatment of herpes zoster ophthalmicus in people with an otherwise normal immune system The aim of this Cochrane Review was to find out if valacyclovir performs better than acyclovir in the treatment of a painful itchy rash caused by the chickenpox virus (herpes zoster ophthalmicus).

Cochrane researchers collected and analysed all relevant studies to answer this question and found one study. Vaccination for preventing postherpetic neuralgia Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat. Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required.

Question: What is the medical condition Herpes Zoster commonly called?
Answer: Shingles