Family Medicine

Answer 1 Postherpetic neuralgia. Herpes zoster occurs as a result of reactivation of the varicella-zoster virus in the dorsal root ganglia. The virus can remain latent for decades and reactivates following a decrease in virus-specific cell-mediated immunity. The virus travels down the sensory nerve, which leads to a dermatomal distribution of skin lesions and pain. The lifetime incidence of herpes zoster infection is estimated to be between 10% and 20%, with the incidence increasing sharply with advanced age.1 The most common complication of herpes zoster is postherpetic neuralgia, pain that persists well after the lesions and rash have healed. Postherpetic neuralgia is more common in patients aged older than 60 years.1 Approximately 20% of patients who have herpes zoster infection will develop postherpetic neuralgia. Herpes zoster lesions may become secondarily infected, resulting in cellulitis; however, this complication occurs in only 2% to 3% of herpes zoster-infected patients. Encephalitis and muscular weakness are much less common complications of herpes zoster infection as compared with postherpetic neuralgia. REFERENCE 1. Mounsey A, Matthew L, Slawson D. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician 2005;72:1075-80. Click here to return to the questions

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