The management of shingles

Shingles or herpes zoster is caused by reactivation of the varicella zoster virus, generally many years after the initial infection.¹

Primary infection with the varicella zoster virus causes chickenpox, and usually occurs in childhood. After the primary infection, there is a permanent asymptomatic latent infection. The virus resides in the sensory cranial nerves and the sensory dorsal root ganglia.¹

The virus can become re-activated, especially in immunosuppressed individuals, for example, those taking immunosuppressive medication or with HIV. Increasing age is a risk factor for varicella zoster reactivation, and this may be related to a decline in cell-mediated immunity. Furthermore, increasing age is associated with a more severe clinical manifestation of shingles.²