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The time between exposure to the virus and eruption of symptoms is called the incubation period. Chickenpox itself usually occurs only once, although mild second infections, marked by the telltale rash, have been reported in older children years after their first infection.
Pain is so common to all stages of herpes zoster that doctors often refer to all syndromes with a single term: Zoster-Associated Pain (ZAP). The prodrome stage lasts 1 - 5 days before the infection becomes active and the skin rash erupts.
The rash that marks the active infection follows the same track of inflamed nerves as the prodrome pain. Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes zoster. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. The varicella zoster virus is a type of herpes simplex virus (HSV) but is not the same as the herpes simplex virus that causes genital herpes. Herpes zoster is not a virus but a syndrome that arises with reactivation of the varicella zoster virus (VZV) years or even decades after chickenpox. Herpes zoster is the same as shingles, an alternative and commonly used name for this condition. Herpes zoster is more likely to occur in a person with a depressed immune system and the elderly.
Herpes zoster, commonly known as just zoster or shingles, is a condition caused by the reactivation of the varicella zoster virus (VZV). Shingles is the syndrome where a painful skin rash marked by the presence of tiny blisters usually forms on a dermarcated area on the skin surface of the head or trunk.
Once the virus reactivates, it causes inflammation of the nerves and is therefore also known as acute posterior ganglionitis. However, shingles often arises for no known reason even in a person without any of these contributing factors. Images from CDC (1)The main symptoms of herpes zoster (shingles) is an itchy skin rash and pain which has been discussed in detail below.
Herpes zoster mainly affects sensory nerves but motor nerves that control muscles may also be affected. Pain that lasts for longer than a month, even after the rash clears, is most likely a complication of shingles known as post-herpetic neuralgia.
All images have been sourced from the Dermatology Atlas (2) courtesy of Samuel Freire da Silva, M.D. Tricyclic antidepressants, anticonvulsants and corticosteroids along with anesthetics may be needed for post-herpetic neuralgia. Treatment should be commenced immediately once a diagnosis of shingles is made, preferably within the first few days of the onset of the rash.


Zoster vaccine to prevent shingles and should be considered only for a person older than 60 years of age.
Ask a Doctor Online Now!Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. History of Present Illness: Patient has noticed a three day history of decreased visual acuity OD, right periorbital headache, and right periorbital rash. External and anterior segment examination: Cornea was clear with no dedritic nor pseudodentritic forms. B: Crops of vessicular lesions in V2 distribution well delineated on upper lip and oropharynx.
Of interest in this patient is the presence of ectropion secondary to a significant amount of localized induration and edema.
Course: The patient did have some persisting pain and parasthesias in the V2 distribution even after resolution of the skin lesions. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. After the active phase of the infection resolves, the virus stays dormant at the spinal nerve root, specifically the dorsal root ganglion. It mainly affects the sensory nerves but can sometimes involve the motor nerves – those nerves that control muscles in the body. These symptoms usually settle after 10 to 15 days but can take up to one month to resolve completely. This gives rise to symptoms such as paralysis of the diaphragm, bladder and bowel problems, cranial nerve palsies and muscle weakness. A dermatome is an area of the skin which is innervated by nerves from a single spinal root. However, if the infection occurs in a vaccinated person it is usually less severe and shorter in duration. The virus lies dormant in sensory nerve ganglia until it reactivates in the distribution of the affected ganglia. This was secondary to suspected bacterial cellulitis superimposed on the affected area, as can often occur with zoster skin lesions. The patient often develops fever, headache, swollen glands, and other flu-like symptoms before the typical rash appears. They become larger within a few hours and spread quickly (sprout), eventually forming small blisters on a red base. The pain may be experienced as sharp, aching, piercing, tearing, or similar to an electric shock. Healing takes even longer in patients who have impaired immune systems, and, in such cases, the blisters may last for months. Symptoms include burning or shooting pain, numbness, tingling, itching, headache, fever, chills, and nausea.


Shingles can affect any age group but is more commonly seen in the elderly and those with depressed immune defenses. Although the peripheral nerves to the trunk is commonly affected, the virus may cause inflammation of any part of the nervous system, even the brain (encephalitis), meninges (meningitis) or both (meningoencephalitis). There was initial concern that scarring of the cheek could have resulted in permanent ectropion.
Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. The varicella zoster virus causes the common childhood infection known as chickenpox which resolves after a few weeks. The virus targets certain nerves with symptoms such as the rash and pain being isolated to those areas of the skin supplied by a single spinal nerve. In ophthalmology, particular attention is paid to rule out involvement of the eye resulting in keratitis, iritis, or acute retinal necrosis. However, prompt treatment with ocular lubrication, oral acyclovir for the zoster, and oral cephalexin (Keflex®) for the cellulitis resulted in resolution without corneal damage nor permanent ectropion (Figure 2).
If the face is affected, there is a danger that the infection can spread to the eye or mouth. Some evidence suggests that some cases of Bell's palsy (in which part of the face becomes paralyzed) might actually be an indication of zoster sine herpete. However, the virus remains dormant for long periods of time in the body and may sometimes reactivate to cause inflammation of the nerve roots. Although shingles resolves within a month, it can sometimes lead to complications or the pain can persist for months thereafter (post-herpetic neuralgia).
A rash that follows the side of the nose is a warning that the cornea of the eye is in danger.
Any duplication or distribution of the information contained herein is strictly prohibited. This does not happen in every person who had chickenpox and is more frequently seen in diminished immune states. Vaccines provide an effective albeit not guaranteed protection against developing shingles.
In this particular patient, there was no evidence of the corneal involvement nor intraocular inflammation that can sometimes be seen with herpes zoster. Usually separate crops of blisters occur over 4 - 7 days, the entire disease process lasting 7 - 10 days.



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