Herpes Zoster (Shingles)MANAGEMENT

DERMATOLOGY PRESENTATIONS · 12 SECTIONS

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613 items

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Allergic contact dermatitis Bullous Pemphigoid Cutaneous Abscess DRESS syndrome Eczema Herpeticum Erysipelas Erythema multiforme Henoch-Schönlein purpura Herpes Zoster (Shingles)Herpetic Whitlow Hidradenitis suppurativa Paronychia Pediculosis (Lice)Pemphigus Vulgaris Pilonidal Abscess Pressure injury Psoriasis (acute flare)Psoriasis Flare Staphylococcal Scalded Skin Syndrome Stevens-Johnson Syndrome (SJS)Toxic Epidermal Necrolysis (TEN)Urticaria (acute)Warfarin-induced Skin Necrosis

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp33

Alarm features requiring immediate action

›High-risk presentations triggering urgent escalation

›Herpes zoster ophthalmicus (HZO)

›V1 trigeminal dermatome with eye pain, redness, or visual change

›Hutchinson sign: vesicles on tip or side of nose

›Urgent ophthalmology referral — risk of keratitis, uveitis, and vision loss

›Ramsay Hunt syndrome

›Facial palsy with vesicles in external ear canal

›Associated hearing loss or vertigo

›Poorer prognosis than Bell palsy; ENT or neurology referral

›Disseminated zoster

›Greater than 20 vesicles outside the primary and adjacent dermatomes

›Suggests immunocompromise; admission for IV antivirals

›CNS complications

›Encephalitis, myelitis, or VZV vasculopathy

›CT or MRI brain emergently; neurology consultation

›Visceral dissemination in immunocompromised

›Hepatitis, pneumonitis, or pancreatitis

›May precede rash by days; high mortality if untreated

Monitoring and resuscitation targets

›Vital sign targets and monitoring bundle

›Temperature: fever common; high fever suggests bacterial superinfection

›Pain score on 0–10 scale every reassessment

›Oxygen saturation if respiratory symptoms suggesting pneumonitis

›Neurological status: GCS if encephalitis suspected

›Escalation triggers

›GCS less than 14: emergent CT head, neurology consult

›Acute vision loss in HZO: immediate ophthalmology

02History/hx59

Prodrome and symptom onset

›Prodromal symptoms preceding rash by 2–3 days

›Burning, tingling, or itching localized to affected dermatome

›Malaise and low-grade fever

›Headache

›Rash characteristics

›Timing of first skin lesion relative to pain onset

›Unilateral distribution not crossing midline

›Dermatomal pattern: erythematous macules progressing to vesicles

›Lesion staging: macules, papules, clear vesicles, cloudy or pustular, crusting over 7–10 days

Pain characterization

›Pain quality and severity

›Burning, lancinating, or sharp quality

›Constant versus intermittent pattern

›Severity on 0–10 numeric rating scale

›Allodynia: pain from light touch in the dermatome

›Hyperesthesia or dysesthesia

Alarm symptom screen

›Ophthalmic symptoms if facial or V1 involvement

›Eye pain, redness, or photophobia

›Blurred vision or visual loss

›Tearing or discharge

›Otologic and facial symptoms

›Ear pain or vesicles in ear canal

›Facial weakness or asymmetry

›Hearing loss or vertigo

›Tinnitus

›Neurological symptoms

03Physical Exam/exam51

Vital signs

›Stability snapshot

›Temperature: low-grade fever typical; high fever suggests superinfection

›Heart rate: tachycardia from pain

›Blood pressure: baseline

›Respiratory rate: elevated if pneumonitis present

›Oxygen saturation: room air if systemic symptoms

Skin examination

›Rash distribution and morphology

›Unilateral dermatomal pattern not crossing midline

›Most common sites: thoracic (40–50%), cranial nerve (20–25%), cervical (15–20%), lumbar (15%), sacral (5%)

›Lesion staging: macules, papules, vesicles, pustules, crusts

›Lesions in various stages of development simultaneously

›Dissemination assessment

›Greater than 20 lesions outside the primary dermatome indicates dissemination

›Bilateral or non-dermatomal distribution raises concern for immunocompromise

›Secondary infection signs

›Purulent or honey-crusted lesions

›Surrounding erythema or warmth suggesting cellulitis

Cranial nerve and ophthalmic examination

›Hutchinson sign

›Vesicles on tip or side of nose: nasociliary branch involvement

›High predictive value for ocular complications in V1 zoster

›Ocular exam in V1 zoster

›Visual acuity

›Pupillary response and size

›Conjunctival injection or chemosis

›Fluorescein staining for corneal dendrites or pseudodendrites

04Differential Diagnosis/ddx44

Dermatomal rash mimics

›Herpes simplex virus infection

›ICD-10 B00.9

›May mimic zoster especially in recurrent cases

›Typically smaller vesicle cluster, may cross dermatomes

›PCR of vesicular fluid differentiates

›Contact dermatitis

›ICD-10 L23.9

›Vesicular and pruritic but bilateral distribution

›Follows exposure pattern not dermatomal

›Impetigo

›ICD-10 L01.00

›Superficial honey-crusted lesions

›Culture positive for Staphylococcus or Streptococcus

›Dermatitis herpetiformis

›ICD-10 L13.0

›Bilateral, symmetric, intensely pruritic papulovesicles

›Associated with celiac disease

Pain without rash mimics

›Acute coronary syndrome

›ICD-10 I24.9

›Thoracic zoster prodrome may mimic

›ECG and troponin to exclude

›Renal colic

›ICD-10 N23

›Flank or groin pain in lumbar or sacral zoster prodrome

›Urinalysis and imaging if diagnostic uncertainty

›Trigeminal neuralgia

05Laboratory Tests/lt40

Confirmatory virology

›PCR of vesicular fluid

›Most sensitive and specific test for VZV confirmation

›Indicated for atypical presentations, immunocompromised hosts, or diagnostic uncertainty

›Can differentiate VZV from HSV in ambiguous cases

›Direct fluorescent antibody testing

›Rapid result but lower sensitivity than PCR

›Vesicle scraping or unroofed lesion base required

›Tzanck smear

›Multinucleated giant cells present

›Low specificity: cannot differentiate VZV from HSV

›Historical test; superseded by PCR

›Viral culture

›Very low sensitivity and slow turnaround

›Not recommended for routine diagnosis

Serology

›VZV IgG and IgM antibodies

›Limited utility in acute diagnosis

›Rising IgG titres may confirm retrospectively

›Useful in zoster sine herpete when PCR unavailable

Baseline metabolic and renal function

›Complete metabolic panel

›Serum creatinine and eGFR for antiviral dose adjustment

›Renal impairment requires valacyclovir and acyclovir dose reduction

›Adequate hydration essential to prevent crystalline nephropathy

›Complete blood count

›Leukopenia suggesting immunosuppression

›Leukocytosis suggesting bacterial superinfection

06Diagnostic Tests/dt54

Scoring Systems

›Postherpetic neuralgia risk scoring

›Age greater than 50 years: strongest predictor of PHN

›Severe acute pain: high pain scores predict PHN development

›Severe rash: large dermatomal area correlates with PHN risk

›Ophthalmic involvement: elevated PHN risk in HZO

›PHN develops in approximately 10–15% overall, rising to 20–30% in those over 60

›Ramsay Hunt severity assessment

›House-Brackmann grading for facial nerve function

›Grade I: normal function

›Grade VI: complete paralysis

›Higher grades predict poorer recovery

›Electroneuronography if facial palsy present

›Immunocompromise severity

›CD4 count in HIV: below 200 cells/mcL predicts severe or disseminated disease

›Hematopoietic stem cell transplant: highest risk group, OR 4.51

MRI

›MRI brain and orbits indications

›Neuro-ophthalmic complications

›Optic neuropathy suspected

›Cranial nerve palsies beyond CN V

›Cavernous sinus involvement

›VZV vasculopathy and stroke

›Stroke symptoms days to months after zoster

›Vessel-wall MRI to identify VZV arteritis

›Ramsay Hunt syndrome

›Enhancement of geniculate ganglion and facial nerve

›Labyrinthine signal change

07Disposition/dispo34

Discharge criteria

›Patients suitable for outpatient management

›Immunocompetent with uncomplicated dermatomal zoster

›Pain controlled with oral medications

›Able to tolerate oral antivirals

›Adequate hydration maintainable orally

›No ophthalmic or neurological complications

›Reliable follow-up within 1–2 weeks

Admission criteria

›Indications for inpatient admission

›Disseminated zoster or visceral involvement

›Severe immunocompromise with extensive disease

›CNS complications: encephalitis, myelitis, or VZV vasculopathy

›Severe ophthalmic zoster requiring IV antivirals

›Intractable pain unresponsive to oral analgesics

›Inability to tolerate oral medications or maintain hydration

›Bacterial superinfection requiring IV antibiotics

Specialist consultation triggers

›Urgent ophthalmology

›Any V1 involvement or Hutchinson sign

›Eye pain, visual change, or redness

›ENT or neurology

›Ramsay Hunt syndrome with facial palsy

›Neurology

›Suspected VZV vasculopathy, stroke, encephalitis, or myelitis

›Infectious disease

›Immunocompromised patients with complicated disease

›Acyclovir-resistant VZV suspected

08Treatment/t99

Antiviral therapy

›First-line oral antivirals (preferred agents)

›Valacyclovir 1,000 mg PO TID for 7 days

›Preferred over acyclovir: better bioavailability and simpler dosing

›Median pain duration 38 days vs 51 days with acyclovir (P=0.001)

›Extend to 7–10 days in immunocompromised or slow-healing lesions

›Renal dose adjustment required: CrCl 30–49 mL/min: 1 g q12h; CrCl 10–29 mL/min: 1 g q24h

›Famciclovir 500 mg PO TID for 7 days

›Alternative first-line agent; equivalent efficacy to valacyclovir

›Extend to 7–10 days in immunocompromised

›Renal dose adjustment: CrCl 20–39 mL/min: 500 mg q12h; CrCl less than 20 mL/min: 500 mg q24h

›Alternative oral antiviral

›Acyclovir 800 mg PO 5 times daily for 7–10 days

›Lower bioavailability than valacyclovir or famciclovir

›Reserved when preferred agents unavailable or cost is prohibitive

›Ensure adequate hydration to prevent crystalline nephropathy

›Intravenous antiviral for severe disease

›IV acyclovir 10 mg/kg IV q8h for 7–10 days

›Indications: disseminated zoster, CNS involvement, severe immunocompromise, or severe ophthalmic zoster

›Infuse over 1 hour to reduce nephrotoxicity risk

›Monitor renal function every 48–72 hours

›Ensure IV hydration to maintain urine output

›Antiviral timing

›Start within 72 hours of rash onset for maximal benefit

›Extend indication beyond 72 hours if new lesions still forming

›CNS or ophthalmic complications: treat regardless of rash onset timing

›Acyclovir-resistant VZV

›Foscarnet 40 mg/kg IV q8h or 60 mg/kg IV q12h

›Reserved for acyclovir-resistant VZV in immunocompromised patients

›Monitor renal function and electrolytes closely

Pain management

›Mild pain

›Acetaminophen 500–1,000 mg PO q4–6h as needed

›Maximum 4 g/day in healthy adults

›Reduce to 2 g/day with hepatic impairment or alcohol use

›NSAIDs: ibuprofen 400–600 mg PO q6–8h with food

›Caution in renal impairment, elderly, and those on antivirals with nephrotoxicity potential

›Moderate to severe acute pain

›Short-course opioids

›Oxycodone 5 mg PO q4–6h as needed for breakthrough pain

›Lowest effective dose for shortest duration

›Re-evaluate at 3–5 days; avoid prolonged use

›Gabapentin for neuropathic component

›Start 300 mg PO TID; titrate up to 1,800–3,600 mg/day in divided doses

›Renal dose adjustment required

›Reduces acute and subacute zoster pain

›Pregabalin alternative

›75 mg PO BID; titrate to 150 mg BID as tolerated

›Renal dose adjustment required

›Adjuvant for PHN prevention

›Amitriptyline 25 mg PO at bedtime

›One RCT showed reduced pain at 6 months

›ECG before initiation in elderly: QT prolongation risk

›Start low, titrate slowly; anticholinergic caution in elderly

›Topical lidocaine 5% patch

›Apply to most painful area for up to 12 hours per 24-hour period

›For localized neuropathic pain

›Minimal systemic absorption

›Corticosteroids

›Prednisone 60 mg PO daily tapering over 21 days when combined with antivirals

›May improve acute quality of life and reduce acute neuritis

›Does NOT prevent postherpetic neuralgia

›Avoid in immunocompromised patients without antiviral coverage

›Caution: hypertension, diabetes, peptic ulcer disease

Ophthalmic zoster treatment

›Topical ophthalmic agents (in consultation with ophthalmology)

›Topical corticosteroid drops for stromal keratitis or anterior uveitis

›Topical antiviral drops not required for VZV (unlike HSV keratitis)

›Lubricating drops for ocular surface protection

›Intraocular pressure management

›Topical beta-blocker or carbonic anhydrase inhibitor if IOP elevated

›IV acyclovir preferred for severe HZO with vision-threatening complications

Ramsay Hunt syndrome treatment

›Combined antiviral and corticosteroid regimen

›Valacyclovir 1,000 mg PO TID for 7 days plus prednisone 60 mg daily tapering over 21 days

›Combined therapy superior to antivirals alone for facial nerve recovery

›Cochrane review supports combined regimen (Uscategui 2008)

›Facial nerve protection

›Eye patching or moisture chamber if eye closure incomplete

›Lubricating eye drops and nighttime eye ointment

›Vestibular rehabilitation if vertigo persists

Wound care

›Lesion care

›Keep lesions clean and dry

›Calamine lotion for itch and comfort

›Cover vesicular lesions to reduce transmission to susceptible contacts

›Avoid topical antibiotics unless bacterial superinfection confirmed

Postherpetic neuralgia treatment

›First-line agents for established PHN

›Gabapentin 300 mg TID titrated to 1,800–3,600 mg/day

›ACEP Level B evidence for neuropathic pain in PHN

›Reduce dose in renal impairment

›Pregabalin 75–150 mg BID titrated to 300 mg BID

›Tricyclic antidepressants: nortriptyline 10–25 mg at bedtime preferred over amitriptyline in elderly

›Fewer anticholinergic effects than amitriptyline

›Titrate to effect over weeks

›Second-line and adjuvant options

›Topical lidocaine 5% patch for localized PHN

›Capsaicin 8% patch: applied by trained provider, significant pain reduction

›Opioids: tramadol or oxycodone as last resort with specialist oversight

Vaccination for prevention

›Shingrix recombinant zoster vaccine

›Two-dose series recommended for adults 50 years and older

›97% efficacy in preventing herpes zoster in adults 50–69

›Defer vaccination approximately 3 years after acute episode in immunocompetent patients

›AAAAI 2026 guidelines support Shingrix for all immunocompetent older adults

09Special Populations/sp58

Pregnancy

›VZV reactivation in pregnancy

›Localized herpes zoster generally not life-threatening to mother or fetus

›Unlike primary varicella, zoster in pregnancy rarely causes congenital VZV syndrome

›Neonatal exposure risk: cover lesions, avoid direct contact until crusted

›Antiviral safety in pregnancy

›Acyclovir: Category B; used in pregnancy when benefit outweighs risk

›Oral acyclovir 800 mg PO 5 times daily for 7 days

›IV acyclovir for severe or disseminated disease

›Valacyclovir: limited data in pregnancy; generally considered safe based on acyclovir registry data

›Famciclovir: inadequate data; not preferred in pregnancy

›Pain management in pregnancy

›Acetaminophen: safest analgesic in all trimesters

›NSAIDs: avoid in third trimester (premature ductus arteriosus closure)

›Opioids: use with caution; neonatal withdrawal risk with prolonged use

›Gabapentin: limited safety data; avoid if possible; discuss with obstetrics

›Corticosteroids in pregnancy

›Avoid routine corticosteroids; discuss with obstetrics if required

›Vaccination contraindication

›Shingrix not studied in pregnancy; defer until postpartum

Geriatric

›Elevated risk profile in older adults

›Incidence and severity increase sharply after age 60

›PHN risk 20–30% in adults over 60 years

›Comorbidities increase risk of disseminated or complicated disease

›Antiviral dosing in renal impairment

›Creatinine clearance 30–49 mL/min: valacyclovir 1 g q12h

›Creatinine clearance 10–29 mL/min: valacyclovir 1 g q24h

10Background/b69

Epidemiology

›Incidence and prevalence

›Greater than 1 million cases annually in the United States

›Lifetime risk approximately 30% for the general population

›Incidence 3.4–4.8 per 1,000 person-years in immunocompetent adults

›Risk rises sharply after age 50; highest incidence in adults over 70

›Risk group data

›Hematopoietic stem cell transplant: OR 4.51 for herpes zoster

›HIV with CD4 less than 200: markedly elevated risk

›Recurrence rate approximately 5% in immunocompetent and 20–30% in HIV-positive patients

›Comorbid conditions (COPD, CKD, diabetes) in adults 30–49 years confer HZ risk comparable to immunocompetent adults aged 50–59

›PHN burden

›Develops in approximately 10–15% of all herpes zoster patients

›Incidence rises to 20–30% in adults over 60

›Pain lasting more than 90 days after rash onset defines PHN

›ICD-10 coding

›B02.9 Zoster without complications

›B02.0 Zoster encephalitis

›B02.1 Zoster meningitis

›B02.21 Postherpetic geniculate ganglionitis (Ramsay Hunt)

›B02.30 Zoster ocular disease, unspecified

›B02.7 Disseminated zoster

›B02.89 Other complications of zoster (including vasculopathy)

›G53 Cranial nerve disorders in zoster

Pathophysiology

›Primary infection and latency

›Varicella-zoster virus (VZV) is a member of the herpesvirus family

›Primary infection (chickenpox) occurs via respiratory droplets or contact with vesicular fluid

›VZV travels via sensory nerve axons to dorsal root ganglia or cranial nerve ganglia

›Establishes lifelong latency in sensory neurons

›Reactivation mechanism

›Decline in VZV-specific T-cell immunity triggers reactivation

›VZV travels anterograde along sensory nerve to skin

›Produces the characteristic dermatomal vesicular eruption

›Ganglionic necrosis and haemorrhage produce the acute neuritis

›Postherpetic neuralgia mechanism

›Viral damage to peripheral and central pain pathways

›Loss of large myelinated inhibitory afferents

›Central sensitization and altered pain processing

›Allodynia and hyperalgesia from damaged nociceptors

›Complications pathophysiology

›HZO: direct corneal invasion via nasociliary branch; immune-mediated inflammation

›Ramsay Hunt: involvement of geniculate ganglion affecting CN VII and VIII

›VZV vasculopathy: direct viral invasion of cerebral vessel walls causing inflammation and occlusion

›Disseminated zoster: haematogenous spread when T-cell immunity severely impaired

Therapeutic Considerations

›Antiviral selection rationale

›Valacyclovir and famciclovir preferred over acyclovir

›Valacyclovir is an L-valyl ester prodrug of acyclovir with 3–5 times higher oral bioavailability

›Simpler dosing improves adherence: TID vs 5 times daily for acyclovir

›Clinical trial data: median pain duration 38 days vs 51 days for acyclovir (P=0.001)

›IV acyclovir remains standard for severe or CNS disease

›PHN prevention strategy

›Early antiviral therapy is the most evidence-based intervention to reduce PHN risk

›Corticosteroids do not reduce PHN incidence despite improving acute pain

›Amitriptyline initiated during acute episode may reduce pain at 6 months

›Vaccination evidence

›Shingrix (recombinant zoster vaccine with AS01B adjuvant)

›97.2% efficacy in preventing herpes zoster in adults 50–69 years

›91.3% efficacy in adults 70 years and older

›91.2% efficacy in preventing PHN in those who develop herpes zoster

›Two-dose series 2–6 months apart; both doses required for full protection

›AAAAI 2026 guidelines recommend Shingrix for all immunocompetent adults 50 years and older

›Immunocompromised host considerations

›IV acyclovir initiation in any immunocompromised patient with evidence of dissemination

›Extend antiviral duration to 10–14 days; continue until all lesions crusted

›Foscarnet for acyclovir-resistant VZV (usually TK-deficient mutants from prolonged exposure)

›JAK inhibitors and anifrolumab: hold if possible during acute episode

›Infection control

›Localized zoster: not airborne; standard and contact precautions

›Disseminated zoster: airborne and contact precautions (may behave like varicella)

›Susceptible healthcare workers should not care for disseminated zoster patients

11Patient Discharge Instructions/pdi41

copy discharge instructions

›Diagnosis and cause

›Herpes zoster (shingles) is caused by reactivation of the chickenpox virus in nerve roots

›Once you have had chickenpox, the virus can remain dormant in your nerves for years

›Stress, illness, or a weakened immune system can trigger reactivation

›Your medication instructions

›Take your antiviral medication (valacyclovir or famciclovir) exactly as prescribed

›Take all doses for the full course even if the rash starts healing

›Start as soon as possible: antivirals work best when started early

›For pain: take acetaminophen or ibuprofen as directed

›Stronger pain medications prescribed: take only as needed

›Gabapentin or pregabalin: do not stop suddenly; side effects include drowsiness

›Drink plenty of fluids while taking antiviral medication

›Wound and skin care

›Keep rash clean and dry

›Apply calamine lotion to reduce itching

›Cover rash with clean loose clothing or light bandage to prevent spreading

›Do not pop or scratch blisters

›Contagion and contact precautions

›You cannot give someone shingles, but you CAN spread chickenpox to someone who has never had it

›Avoid direct contact with rash fluid until all blisters have crusted over

›Avoid pregnant women who have not had chickenpox or the vaccine

›Avoid newborn babies and immunocompromised individuals until crusted

›Expected course

›New blisters form for 3–5 days, then crust over by 7–10 days

›Skin usually heals within 2–4 weeks

›Some pain may last after the rash heals (postherpetic neuralgia); follow up if this occurs

›Follow-up appointments

12References/r31

Guidelines and key sources

›Cohen JI. Herpes Zoster. New England Journal of Medicine 2013

›Comprehensive review covering epidemiology, treatment, and antiviral data

›Primary evidence base for antiviral selection and timing

›Behera D, Belemkar S. Epidemiology, Treatment, and Management of Herpes Zoster. Current Pharmaceutical Design 2026

›Updated review of HZ epidemiology, risk factors, and management

›Saguil A et al. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. American Family Physician 2017

›PHN risk factors and pain management strategies

›Gilden DH et al. Neurologic Complications of Reactivation of Varicella-Zoster Virus. NEJM 2000

›VZV encephalitis, myelitis, and vasculopathy; CNS complication management

›Whitley RJ. A 70-Year-Old Woman With Shingles: Review of Herpes Zoster. JAMA 2009

›Clinical review with epidemiology and treatment updates

›Uscategui T et al. Antiviral Therapy for Ramsay Hunt Syndrome. Cochrane Database 2008

›Combined antiviral and corticosteroid therapy for Ramsay Hunt evidence

›Johnson RW, Rice AS. Postherpetic Neuralgia. NEJM 2014

›PHN pathophysiology, incidence, and treatment evidence

›Gan EY, Tian EA, Tey HL. Management of Herpes Zoster and Post-Herpetic Neuralgia. American Journal of Clinical Dermatology 2013

›PHN treatment options including topical agents

›Espinoza S et al. High-Resolution MRI for Early Diagnosis of Orbital and Neurovascular Involvement in HZO. American Journal of Ophthalmology 2026

›MRI protocol for HZO neuro-ophthalmic complications

›Slimovitch J et al. Recommended Vaccines for Immunocompetent Older Adults. Journal of Allergy and Clinical Immunology in Practice 2026

›AAAAI 2026 Shingrix vaccination recommendations

›McKay SL et al. Herpes Zoster Risk in Immunocompromised Adults in the United States. Clinical Infectious Diseases 2020

›Systematic review of HZ risk in immunocompromised populations

›IDSA/OARAC Guidelines for Prevention and Treatment of Opportunistic Infections in Adults with HIV 2025

›VZV management in HIV-positive patients; CD4-specific guidance

›Adriaansen EJM et al. Herpes Zoster and Post Herpetic Neuralgia. Pain Practice 2024

›Evidence-based PHN management framework

Learn More: Herpes Zoster (Shingles)→

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Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.