Intended for healthcare professionals

Clinical Review Clinical review

Herpes zoster

BMJ 2007; 334 doi: (Published 07 June 2007) Cite this as: BMJ 2007;334:1211
  1. David W Wareham, senior clinical lecturer (honorary consultant) in medical microbiology,
  2. Judith Breuer, professor of virology (honorary consultant)
  1. Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and the London, Queen Mary's School of Medicine and Dentistry, London E1 2AT and Division of Infection, Barts and the London NHS Trust, London E1 1BB
  1. Correspondence to: D Wareham d.w.wareham{at}
  • Accepted 19 April 2007

Herpes zoster is a clinical manifestation of the reactivation of latent varicella zoster virus infection. It is a cause of considerable morbidity, especially in elderly patients, and can be fatal in immunosuppressed or critically ill patients. The pain associated with herpes zoster can be debilitating, with a serious impact on quality of life, and the economic costs of managing the disease represent an important burden on both health services and society.1 Here we provide an overview of the disease and a summary of “best practice guidance” for the management of herpes zoster and its sequelae.

Summary points

  • Herpes zoster and postherpetic neuralgia are common causes of debilitating neuropathic pain

  • Systemic antiviral agents reduce both the acute pain of herpes zoster and the incidence of postherpetic neuralgia

  • Corticosteroids, tricyclic antidepressants, gabapentin, and opioids reduce acute pain and may have additional effects on the reduction of postherpetic neuralgia

  • Tricyclic antidepressants, gabapentin, opioids, and lidocaine patches are effective in established postherpetic neuralgia

  • Large scale vaccination of children and older adults may have an important impact on the incidence of herpes zoster and postherpetic neuralgia

Sources and selection criteria

We searched Pubmed (2001-6) by using the terms “herpes zoster OR postherpetic neuralgia” with the limits “meta-analysis and randomised controlled trial.” We searched all reviews in the Cochrane library with the same terms. We also reviewed recent recommendations made by an expert body on the management of herpes zoster sponsored by the International Association for the Study of Pain, the Neuropathic Pain Institute, and the VZV Foundation. We also drew heavily on published management guidelines from the British Infection Society, the International Herpes Management Forum, the German Dermatology Society, and the Quality Standards Subcommittee of the American Academy of Neurology

What is herpes zoster and who gets it?

Herpes zoster, or shingles, is the painful eruption of a rash, usually unilateral, caused by the varicella zoster virus. Varicella …

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