Herpes zoster-prevention, diagnosis, and treatment

Background Herpes zoster (HZ) is a common skin disease resulting from a regionally limited reactivation of a latent infection with the varicella zoster virus (VZV). Despite its usually self-limiting course, HZ is associated with a considerable individual and public health burden of disease, particularly due to its high rate of postherpetic neuralgia (PHN). Objectives To improve knowledge of the current recommendations for the prevention, diagnosis and treatment. Materials and methods Narrative review and summary of current guideline recommendations. Results In Germany, the recombinant VZV subunit zoster vaccine is recommended for all adults of 60+ years and for immunocompromised persons of 50+ years. The diagnosis of HZ is clinical; in case of uncertainty, laboratory investigations can help confirm the diagnosis. For patients with HZ ophthalmicus, HZ oticus or neurological complications, an interdisciplinary approach is advantageous. Antiviral treatment should be started as early as possible; various factors, including the duration and location of the disease, the patient's age and signs of a complicated course, serve to determine the indication to initiate an antiviral medication. The choice of the appropriate treatment depends, among other factors, on the intravenous availability, comorbidities and intake preferences. Early and sufficient analgesic treatment according to the WHO pain ladder and, if required, with anticonvulsant adjuvants is necessary to treat acute pain and to reduce the risk for PHN. Conclusion Implementation of the current recommendations for the prevention, diagnosis and treatment of HZ and PHN is important to reduce the high burden of disease and improve quality of life of the patients.

Automated summary

Herpes zoster (HZ) is a common skin disease caused by the reactivation of latent infection with varicella zoster virus (VZV). Germany recommends the VZV subunit zoster vaccine for adults aged 60+ and immunocompromised individuals aged 50+. Diagnosis is primarily clinical, with laboratory investigations used to confirm uncertain cases. Early antiviral treatment and adequate pain management are important for reducing complications and improving patient quality of life.