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Herpes zoster (commonly called "shingles") results from reactivation of the
varicella-zoster virus (VZV) acquired during a primary varicella infection (chickenpox).
Primary VZV infection occurs when a susceptible individual (usually a child) is exposed to
airborne virus via a respiratory route. Over 90% of adults in the United States have
evidence of prior VZV infection on blood testing.
While zoster can erupt on almost any part of the body, the most common areas are the face
and the torso. The characteristic rash of herpes zoster is often preceded by a prodrome of
burning pain, itching or sensitivity of the affected area.
The skin lesions begin as a red, raised rash that follows a dermatomal distribution. The
rash evolves into small fluid-filled blisters (vesicles) on a reddened base. The vesicles
are generally painful, and their development is often associated with the occurrence of
flu-like symptoms and anxiety. The vesicles eventually become cloudy and may bleed. Within
7-10 days, the vesicles crust over. As these crusts fall off, scarring and changes in skin
color may remain.
While medications do not cure zoster infections, they have been found to help shorten the
duration and discomfort of the outbreak. Perhaps more importantly, antiviral medications
have been found to help reduce or prevent the occurrence of postherpetic neuralgia pain.
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