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Shingles: Herpes zoster and postherpetic neuralgia

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Mayo Clin Proc. 2009 Mar;84(3):274-80.

Herpes zoster (shingles) and postherpetic neuralgia.

Sampathkumar P, Drage LA, DP.

Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN

55905, USA.

Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused

by reactivation of varicella zoster virus (VZV).

This reactivation occurs when immunity to VZV declines because of aging or

immunosuppression. Herpes zoster can occur at any age but most commonly affects

the elderly population.

Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months

after the rash has healed, is a debilitating and difficult to manage consequence

of HZ.

The diagnosis of HZ is usually made clinically on the basis of the

characteristic appearance of the rash. Early recognition and treatment can

reduce acute symptoms and may also reduce PHN.

A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the

risk of HZ is now available and is recommended for adults older than 60 years.

The vaccine has been shown to reduce significantly the incidence of both HZ and

PHN.

The vaccine is well tolerated, with minor local injection site reactions being

the most common adverse event.

This review focuses on the clinical manifestations and treatment of HZ and PHN,

as well as the appropriate use of the HZ vaccine.

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