History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include: >50 years of age, HIV-positive, chronic corticosteroid use, chemotherapy, malignancies.
localised pain in a dermatome
The pain is localised, burning, stinging, itching, or tingling and ranges from mild to severe.
Pain, localised to the affected dermatome, can precede the rash by days to weeks.
The most commonly involved ganglia are the thoracic and trigeminal nerves.
pruritus
May present in the affected dermatome.
rash
Patients develop an erythematous maculopapular rash, which is followed by the appearance of clear vesicles. The eruption occurs in segments innervated by the affected sensory ganglion, but does not cross the midline. The vesicles eventually pustulate and form crusts.
corneal ulceration
If the trigeminal nerve is affected, the rash may cause corneal ulceration. Patient presents with pain in the affected eye and reduced vision.
Other diagnostic factors
uncommon
fever
May be low-grade. Significant temperature elevations are rare.
headache
About 20% of patients present with systemic symptoms.[3]
malaise
About 20% of patients present with systemic symptoms.[3]
fatigue
About 20% of patients present with systemic symptoms.[3]
pain without rash
Patients can develop typical zoster pain (acute, chronic, or both) without ever developing a rash, a syndrome called zoster sine herpete.[72]
Risk factors
strong
>50 years of age
The incidence increases from age 50.[23]
female sex
Women have a higher incidence of HZ than men.[9]
HIV
Before the availability of antiretroviral therapy (ART), HZ incidence was more than 15 times higher in HIV-infected patients than in uninfected people.[10][11][24] ART has reduced the incidence of HZ in people with HIV, though the risk is still 3 times higher compared with the general population.[13]
chronic corticosteroid use
Chronic use causes immunosuppression, increasing the risk.[25]
chemotherapy
These drugs cause immunosuppression and hence increase risk.
malignancies
Lymphoproliferative malignancies in particular induce immunosuppression, thus increasing the risk of infection.[16]
weak
white ethnicity
One study suggested that black people are far less likely than white people to develop HZ (odds ratio 0.25).[15]
certain acute or chronic conditions
A range of conditions have been associated with an increased risk of HZ, including COVID-19, rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, chronic obstructive pulmonary disease, asthma, chronic kidney disease, type 1 diabetes, cardiovascular conditions, physical trauma, and psychological stress.[26][27][28][29] Prior antibiotic use has also been associated with an increased risk of subsequent herpes zoster infection.[30] Further studies are needed to confirm associations.
Use of this content is subject to our disclaimer