Herpes zoster in the elderly

Herpes zoster is a self-limited disorder which in most cases resolves without complications. The specific defect in host immunity that permits activation of latent V-Z virus and the occurrence of herpes zoster in both healthy and debilitated individuals has not yet been identified. In some patients, particularly the aged, complications occur during the acute phase of the disease or there are sequelae that may incapacitate the patient later. The most important of these is postherpetic neuralgia. In the elderly the chance of developing neuralgia following herpes zoster is about 50%. Involvement of the eye may produce minimal scarring or permanent blindness. There is an increasing incidence and severity of herpes zoster in association with malignant disease and in particular with Hodgkin's disease. Treatment of herpes zoster in the elderly should be determined by presenting symptoms. Topical medication such as the basic shake lotion is helpful. Personal experience and published reports suggest that early systemic administration of corticosteroids to healthy patients with severe herpes zoster pain with lessen the occurrence of postherpetic neuralgia. Administration of herpes zoster immune globulin is only effective in reducing the morbidity or preventing varicella in high risk individuals. ZIG does not affect the clinical course of herpes zoster.