RT Book, Section
A1 Levin, Myron J.
A1 Schmader, Kenneth E.
A1 Oxman, Michael N.
A2 Kang, Sewon
A2 Amagai, Masayuki
A2 Bruckner, Anna L.
A2 Enk, Alexander H.
A2 Margolis, David J.
A2 McMichael, Amy J.
A2 Orringer, Jeffrey S.
SR Print(0)
ID 1161340297
T1 Varicella and Herpes Zoster
T2 Fitzpatrick's Dermatology, 9e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071837798
LK dermatology.mhmedical.com/content.aspx?aid=1161340297
RD 2024/04/24
AB AT  A  GLANCEVARICELLAVaricella  (chickenpox)  and  herpes  zoster  (shingles)  are  distinct  clinical  entities  caused  by  a  single  member  of  the  herpesvirus  family,  varicella-zoster  virus  (VZV).Varicella,  a  highly  contagious  exanthem  that  occurs  most  often  in  childhood,  is  the  result  of  primary  VZV  infection  of  a  susceptible  individual.The  rash  of  varicella  usually  begins  on  the  face  and  scalp  and  spreads  rapidly  to  the  trunk,  with  relative  sparing  of  the  extremities.  Lesions  are  scattered,  rather  than  clustered,  reflecting  viremic  spread  to  the  skin,  and  they  progress  sequentially  from  rose-colored  macules  to  papules,  vesicles,  pustules,  and  crusts.  Lesions  in  all  stages  are  usually  present  at  the  same  time.In  immunocompetent  children,  systemic  symptoms  are  usually  mild  and  serious  complications  are  rare.  In  adults  and  immunocompromised  persons  of  any  age,  varicella  is  more  likely  to  be  severe  and  can  be  associated  with  life-threatening  complications.Varicella  results  in  lifelong  latent  VZV  infection  of  sensory  and  autonomic  neurons,  and  host  immunity  to  VZV.Live  attenuated  Oka  VZV  varicella  vaccines  have  virtually  eliminated  varicella  in  countries  where  they  have  been  deployed.HERPES  ZOSTERHerpes  zoster  is  characterized  by  unilateral  dermatomal  pain  and  rash  that  results  from  reactivation  and  multiplication  of  latent  VZV  that  persisted  within  neurons  following  varicella.The  erythematous  maculopapular  and  vesicular  lesions  of  herpes  zoster  are  clustered  within  a  single  dermatome,  because  VZV  reaches  the  skin  via  the  sensory  nerve  from  the  single  ganglion  in  which  latent  VZV  reactivates,  and  not  by  viremia.Herpes  zoster  is  most  common  in  older  adults  and  in  immunocompromised  individuals.Pain  is  an  important  manifestation  of  herpes  zoster.  The  most  common  debilitating  complication  is  chronic  neuropathic  pain  that  persists  long  after  the  rash  resolves,  a  complication  known  as  postherpetic  neuralgia  (PHN).Antiviral  therapy  and  analgesics  reduce  the  acute  pain  of  herpes  zoster.  Lidocaine  patch  (5%),  high-dose  capsaicin  patch,  gabapentin,  pregabalin,  opioids,  and  tricyclic  antidepressants  may  reduce  the  pain  of  PHN.A  live  attenuated  Oka/Merck  strain  VZV  herpes  zoster  vaccine  (ZVL;  Zostavax®)  reduces  the  incidence  of  herpes  zoster  by  one-half  and  the  incidence  of  PHN  by  two-thirds.  An  adjuvanted  recombinant  glycoprotein  E  subunit  herpes  zoster  vaccine  (RZV;  Shingrix®)  has  substantially  greater  efficacy  for  herpes  zoster  and  PHN,  but  it  requires  2  doses  and  is  more  reactogenic.