Der Hautarzt

, Volume 67, Issue 8, pp 653–665 | Cite as

Herpes zoster und postzosterische Neuralgie



Der Herpes zoster ist eine Folge einer endogenen Reaktivierung von Varizella-Zoster-Viren (VZV). Die Inzidenz nimmt mit dem Lebensalter zu. Frauen sind etwas häufiger betroffen. Die Reaktivierungsrate bei seropositiven Personen liegt bei 20 %. Nach einem kurzen Prodromalstadium treten herpetiform gruppierte Vesikel segmental auf. Schmerzen und Missempfindungen sind charakteristisch. Komplikationen wie sekundäre bakterielle Superinfektion, Vaskulopathie, Paresen und Visusstörungen können auftreten. In der Schwangerschaft bestehen Risiken für Mutter und Kind. In der ersten Krankheitswoche erhöht sich bei älteren Erwachsenen das Risiko kardiovaskulärer Ereignisse. Gefürchtet ist die postzosterische Neuropathie. Die Diagnostik erfolgt meist klinisch oder mittels Polymerasekettenreaktion. Die Therapie der ersten Wahl besteht in der systemischen antiviralen Therapie mit Aciclovir oder Brivudin. Schmerz- und Lokaltherapie erfolgen adjuvant.


Polymerasekettenreaktion Vakzinierung Reaktivierung Aciclovir Brivudin 

Herpes zoster and postherpetic neuralgia


Herpes zoster develops by endogenous reactivation of varizella zoster virus (VZV). Incidence increases with age. Females are more frequently affected than males. The reactivation rate in seropositive individuals is about 20 %. After a short prodromal stage, herpetiform-grouped vesicles appear in segmental arrangement. Pain and paresthesia are typical zoster symptoms. Complications like bacterial superinfections, vasculopathy, paresis, and oculopathy may occur. During pregnancy herpes zoster is a threat for mother and child. Among elderly patients, cardiovascular risk is increased during the first week of herpes zoster infection. Postherpetic neuropathy is feared. Diagnosis can be made clinically and by the use of polymerase chain reaction. First-line treatment is systemic antiviral drug therapy with either acyclovir or brivudine. Adjuvant therapies consist of pain management and topical treatment.


Polymerase chain reaction Vaccination Reactivation Acyclovir Brivudine 


  1. 1.
    Johnson BH, Palmer L, Gatwood J et al (2015) Annual incidence rates of herpes zoster among an immunocompetent population in the United States. BMC Infect Dis 15:502CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW (2013) Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis 13:170CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Robert-Koch-Institut (2000) Seroprävalenz gegen Varicella-Zoster-Virus in Deutschland. Ergebnisse einer Studie des RKI und des Konsiliarlabors für HSV und VZV. Epidemiol Bull 46:368–369Google Scholar
  4. 4.
    Ultsch B, Siedler A, Rieck T et al (2011) Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis 11:173CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Zerboni L, Sen N, Oliver SL, Arvin AM (2014) Molecular mechanisms of varicella zoster virus pathogenesis. Nat Rev Microbiol 12:197–210CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yang E, Arvin AM, Oliver SL (2014) The cytoplasmic domain of varicella-zoster virus glycoprotein H regulates syncytia formation and skin pathogenesis. PLoS Pathog 10:e1004173CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Steiner I, Kennedy PG, Pachner AR (2007) The neurotropic herpes viruses: herpes simplex and varicella-zoster. Lancet Neurol 6:1015–1028CrossRefPubMedGoogle Scholar
  8. 8.
    Robert-Koch-Institut (2013) Stellungnahme der Ständigen Impfkommission (STIKO): Evaluation der Varizellen-Impfempfehlung durch die STIKO. Epidemiol Bull 1:1–5Google Scholar
  9. 9.
    Crosslin DR, Carrell DS, Burt A (2015) Genetic variation in the HLA region is associated with susceptibility to herpes zoster. Genes Immun 16:1–7CrossRefPubMedGoogle Scholar
  10. 10.
    Pillet S, Verhoeven PO, Epercieux A et al (2015) Development and validation of a laboratory-developed multiplex real-time PCR assay on the BD Max System for detection of herpes simplex virus and varicella-zoster virus DNA in various clinical specimens. J Clin Microbiol 53:1921–1926CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Elsaie ML, Shehu YM, Avashia N (2012) Multisegmental herpes zoster in an immunocompetent girl. Cutis 89:36–37, 40PubMedGoogle Scholar
  12. 12.
    Schiller D (2006) Herpes zoster generalisatus bei Diabetes mellitus. Dtsch Med Wochenschr 131:1290CrossRefPubMedGoogle Scholar
  13. 13.
    Wollina U, Schönlebe J (2016) Disseminated specific cutaneous infiltrates of B‑cell chronic lymphocytic leukemia – Wolf’s isotopic response following herpes zoster infection. J Dtsch Dermatol Ges 14:179–181PubMedGoogle Scholar
  14. 14.
    Verma SB, Wollina U (2013) Herpes zoster in pregnancy leading to keloids and post herpetic neuralgia: a double whammy? Indian Dermatol Online J 4:158–159CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wollina U, Schönlebe J (2012) Segmental leukocytoclastic vasculitis in herpes zoster. Int J Dermatol 51:1351–1352CrossRefPubMedGoogle Scholar
  16. 16.
    Wollina U, Gemmeke A (2009) Herpes zoster – associated erythema multiforme. J Dermatol Case Rep 3:11–13CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Minassian C, Thomas SL, Smeeth L et al (2015) Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States. PLoS Med 12:e1001919CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Liesegang TJ (2008) Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity. Ophthalmology 115(2 Suppl):S3–S12CrossRefPubMedGoogle Scholar
  19. 19.
    Kuo CY, Lin YY, Wang CH (2014) Painful rash of the auricle: Herpes zoster oticus. Ear Nose Throat J 93:E47PubMedGoogle Scholar
  20. 20.
    Kim CH, Jeong KH, Ahn SH et al (2015) Vibration- and hyperventilation-induced nystagmus in patients with Ramsay Hunt syndrome with vertigo. Otolaryngol Head Neck Surg 152:912–918CrossRefPubMedGoogle Scholar
  21. 21.
    Wagner G, Klinge H, Sachse MM (2012) Ramsay Hunt syndrome. J Dtsch Dermatol Ges 10:238–244PubMedGoogle Scholar
  22. 22.
    Haanpää M, Dastidar P, Weinberg A et al (1998) CSF and MRI findings in patients with acute herpes zoster. Neurology 51:1405–1411CrossRefPubMedGoogle Scholar
  23. 23.
    Nakamura M, Kanazawa M, Yamaguchi K et al (1996) Pneumonia caused by varicella-zoster virus in a patient with rheumatoid arthritis. Nihon Kyobu Shikkan Gakkai Zasshi 34:610–615PubMedGoogle Scholar
  24. 24.
    Benoit G, Etchemendigaray C, Nguyen-Xuan HT et al (2015) Management of varicella-zoster virus primary infection during pregnancy: a national survey of practice. J Clin Virol 72:4–10CrossRefPubMedGoogle Scholar
  25. 25.
    Babilas P, Roesch A, Szeimies RM et al (2004) Zosteriform pigmented purpura of Schamberg: case report and differential diagnosis of zosteriform skin lesions. J Dtsch Dermatol Ges 2:931–934PubMedGoogle Scholar
  26. 26.
    Wollina U (2015) Herpes zoster. In: Katsambas A, Lotti T, Dessinioti C, D’Erme AM (Hrsg) European handbook of dermatological treatments, 3. Aufl. Springer, Berlin Heidelberg, S 379–384Google Scholar
  27. 27.
    Gross G, Schöfer H, Wassilew S et al (2003) Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol 26:277–289CrossRefPubMedGoogle Scholar
  28. 28.
    Wassilew S, Collaborative Brivudin PHN Study Group (2005) Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients. A randomized, double-blind, multinational study. J Eur Acad Dermatol Venereol 19:47–55CrossRefPubMedGoogle Scholar
  29. 29.
    Shrim A, Koren G, Yudin MH et al (2012) Management of varicella infection (chickenpox) in pregnancy. J Obstet Gynaecol Can 34:287–292CrossRefPubMedGoogle Scholar
  30. 30.
    Sauerbrei A (2011) Preventing congenital varicella syndrome with immunization. CMAJ 183:E169–E170CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Weaver BA, Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (2011) Update on the advisory committee on immunization practices’ recommendations for use of herpes zoster vaccine. J Am Osteopath Assoc 111(Suppl 6):S31–S33PubMedGoogle Scholar
  32. 32.
    Sandherr M, Hentrich M, von Lilienfeld-Toal M et al (2015) Antiviral prophylaxis in patients with solid tumours and haematological malignancies – update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol 94:1441–1450CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Gater A, Uhart M, McCool R, Préaud E (2015) The humanistic, economic and societal burden of herpes zoster in Europe: a critical review. BMC Public Health 15:193CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Scott FT, Leedham-Green ME, Barrett-Muir WY et al (2003) A study of shingles and the development of postherpetic neuralgia in East London. J Med Virol 70:S24–S30CrossRefPubMedGoogle Scholar
  35. 35.
    Watson CP, Deck JH, Morshead C et al (1991) Postherpetic neuralgia: further post-mortem studies of cases with and without pain. Pain 44:105–117CrossRefPubMedGoogle Scholar
  36. 36.
    Rowbotham MC, Fields HL (1996) The relationship of pain, allodynia and thermal sensation in post-herpetic neuralgia. Brain 119:347–354CrossRefPubMedGoogle Scholar
  37. 37.
    Truini A, Galeotti F, Haanpää M et al (2008) Pathophysiology of pain in postherpetic neuralgia: a clinical and neurophysiological study. Pain 140:405–410CrossRefPubMedGoogle Scholar
  38. 38.
    Liu J, Hao Y, Du M et al (2013) Quantitative cerebral blood flow mapping and functional connectivity of postherpetic neuralgia pain: a perfusion fMRI study. Pain 154:110–118CrossRefPubMedGoogle Scholar
  39. 39.
    Moore RA, Chi CC, Wiffen PJ, Derry S, Rice AS (2015) Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Database Syst Rev 10:CD010902PubMedGoogle Scholar
  40. 40.
    Baron R, Binder A, Wasner G (2010) Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 9:807–819CrossRefPubMedGoogle Scholar
  41. 41.
    Pfau DB, Krumova EK, Treede RD et al (2014) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): reference data for the trunk and application in patients with chronic postherpetic neuralgia. Pain 155:1002–1015CrossRefPubMedGoogle Scholar
  42. 42.
    Kommission Leitlinien der Deutschen Gesellschaft für Neurologie (2014) Pharmakologisch nicht interventionelle Therapie chronisch neuropathischer Schmerzen. Unter Mitarbeit von R. et al. Baron. AWMF-Registernummer: 030/114. (Erstellt: 2012). Zugegriffen: 28. Apr. 2016Google Scholar
  43. 43.
    Phan NQ, Siepmann D, Gralow I, Ständer S (2010) Adjuvant topical therapy with a cannabinoid receptor agonist in facial postherpetic neuralgia. J Dtsch Dermatol Ges 8:88–91CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Klinik für Dermatologie und Allergologie, Krankenhaus Dresden-FriedrichstadtStädtisches Klinikum DresdenDresdenDeutschland
  2. 2.Neurologische Klinik, Krankenhaus Dresden-NeustadtStädtisches Klinikum DresdenDresdenDeutschland

Personalised recommendations