Symptoms
Herpes zoster begins with intense pain, itching, and/or numbness in the affected area Table 01. In more than 90% of people, HZ begins with symptoms in and around the affected area. These symptoms precede the HZ rash by about one to three days (although they can occur for up to week before a rash erupts). Symptoms can range from superficial itching, tingling, and burning, to severe, deep, sharp, stabbing pain. The affected area may feel tender and very sensitive when touched. The symptoms can occur either constantly or irregularly. Many people experience flulike symptoms (headache, chills, fever, malaise) and gastrointestinal upset during this time.
A red, bumpy rash erupts in the same area within three or four days Figure 03. Herpes zoster typically erupts as a red, swollen rash that is limited to the chest, abdomen, face, neck, or forehead. The HZ skin lesions blister within 12 to 24 hours, and become filled with pus. The lesions are painful in 60% to 90% of people, are of irregular size, and are limited to a circumscribed area. New lesions generally continue to appear for up to a week. In most people, the HZ blisters begin to heal within 3 to 4 days, dry and crust over within 7 to 10 days, and then fall off. Although uncommon, some people can experience early symptoms and never develop an HZ rash. This condition is known as “zoster without rash,” or zoster sine herpete.
Figure 03. HZ Rash
Table 1. Common Symptoms of HZ in Adults
Common HZ symptoms in Adults Phase 1: Early period (one to seven days) with any of the following symptoms confined to one or two areas on the chest, abdomen, arms, neck, face, or forehead: Superficial itching Numbness Tingling Burning Sensitivity to touch Severe, stabbing, or sharp pain Fever Malaise Headache Chills Gastrointestinal upset Phase 2: Herpes zoster infection erupts on the chest, abdomen, arms, neck, face, or forehead: Red, swollen rash confined to one or two areas Pain Itching Fluid-filled, cloudy blisters that continue to erupt for up to one week, and then rupture, or dry up and crust over Risk Factors
Herpes zoster occurs most often in persons over the age of 50 Table 02. Experts believe that a persons immunity to the varicella virus decreases with age. Two-thirds of reported cases occur in people older than age 50, whereas the disease is rare in children. By age 80, 1 in every 100 people will develop an infection. Infections are also more severe and longer-lasting in the elderly.
In addition, HZ discriminates along racial lines: after age 65, Caucasians are one-third more likely to acquire HZ than are African-Americans.
People with weakened immune systems due to cancer (especially those receiving chemotherapy or radiotherapy), bone-marrow transplant recipients, and HIV patients are at a high risk for HZ, regardless of age. For example, not only do roughly 50% of people with Hodgkins lymphoma develop HZ, but up to half of them will have infections that spread to the brain, lungs, and other parts of the body. Finally, HZ can be the first sign of an HIV infection, especially among younger African-Americans.
Table 2. HZ Risk Factor Checklist
? Age 50 or older (any race) Caucasian age 65 or older HIV+ Hodgkin?s or other cancer Chemotherapy recipient Radiotherapy recipient Organ transplant recipient Long-term corticosteroid use If you are healthy and your age is: Your risk for HZ is: < 9 years old negligible 20 to 50 years old .25 in 100 51 to 79 years old .5 in 100 80 years and older 1 in 100
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I'm Kristen Dore, PharmD. Welcome to PDR Health!