Herpes Zoster and Postherpetic Neuralgia: Common Questions and Answers

Herpes zoster (shingles) is the clinical manifestation of the reactivation of latent varicella-zoster virus from the dorsal root and cranial nerve ganglia. Approximately one-third of the population will develop herpes zoster, which most commonly results in a self-limited, painful, vesicular, dermatomal rash that resolves within 2 to 4 weeks. Complications of herpes zoster can result in chronic debility. Postherpetic neuralgia, a persistent dermatomal pain syndrome lasting longer than 90 days after symptom onset, is the most common complication, occurring in 10% to 18% of people who have herpes zoster. Older adults and immunocompromised individuals are at higher risk of developing herpes zoster and its associated complications. Treatment for herpes zoster involves antiviral medications (eg, acyclovir, valacyclovir, famciclovir) with or without adjunctive pain management. First-line treatment of postherpetic neuralgia includes gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants. Topical drugs are an adjunctive treatment. Herpes zoster and its complications are largely preventable with vaccination (recombinant zoster vaccine), which is covered by Medicare and commercial insurances. Two doses of recombinant zoster vaccine are recommended for adults 50 years and older and those 19 years and older with immunocompromise. Obstacles to receiving vaccination include low awareness, administration errors, necessity of receiving multiple doses, and vaccine adverse effects.