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Herpes zoster - Anogenital in
See also in: Overview,Hair and Scalp,Oral Mucosal Lesion
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Herpes zoster - Anogenital in

See also in: Overview,Hair and Scalp,Oral Mucosal Lesion
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Contributors: Susan Burgin MD, Whitney A. High MD, JD, MEng, Lowell A. Goldsmith MD, MPH, Benjamin K. Fisher MD
Other Resources UpToDate PubMed

Synopsis

Herpes zoster (shingles) is reactivation of a latent infection with the varicella-zoster virus (VZV). After primary infection (chickenpox), the virus lays dormant in dorsal root ganglia for life. Reactivation may be triggered by immunosuppression, certain medications, other infections, or physical or emotional stress. The individual lifetime risk of developing herpes zoster is 1 in 3.

Cutaneous herpes zoster usually begins with a 1-3 day prodrome of burning pain or paresthesias in the affected dermatome, followed by eruption of erythematous papules and vesicles in the same distribution.

Involvement of a thoracic dermatome may simulate acute myocardial infarction. Involvement of the ophthalmic branch of the trigeminal nerve may lead to herpes zoster ophthalmicus. Herpes zoster oticus (Ramsay-Hunt syndrome) occurs with involvement of the vestibulocochlear nerve. Disseminated zoster, defined as >20 vesicles outside of the primary and adjacent dermatomes, is chiefly a problem of immunocompromised patients (patients with human immunodeficiency virus [HIV], patients with cancer, and those on immunosuppressive drugs). Some patients may suffer acute segmental neuralgia, known as zoster sine herpete, without ever developing a visible skin eruption. Regional adenopathy may be seen.

Zoster may be accompanied by pain acutely. Additionally, a major concern after a zoster outbreak is postherpetic neuralgia, defined as pain and neuropathic symptoms that persist in a dermatome one month beyond resolution of the rash. Risk factors for postherpetic neuralgia include older age, female sex, presence of a prodrome, greater rash severity, and acute pain. Postherpetic neuralgia can be intractable and debilitating, and prevention is an important goal.

Cerebrovascular accidents, peripheral motor neuropathies, neurogenic bladder, and diaphragmatic paralysis have been associated with zoster. Herpes zoster encephalitis usually appears in the first 2 weeks after the onset of lesions and it has a 10%-20% mortality rate. Lesions may also be at risk for bacterial superinfection. In extreme cases, necrotizing fasciitis may occur.

Codes

ICD10CM:
B02.9 – Zoster without complications

SNOMEDCT:
4740000 – Zoster

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 07/02/2018
Last Updated: 08/28/2018
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Herpes zoster - Anogenital in
See also in: Overview,Hair and Scalp,Oral Mucosal Lesion
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Herpes zoster : Grouped configuration, Painful skin lesions, Umbilicated vesicle
Clinical image of Herpes zoster
Grouped vesicles on an erythematous base in the T3 distribution.
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