Pustules on One Side of the Face: Herpes Zoster

Abstract

Herpes Zoster (HZ) or shingles occurs as a result of reactivation of varicella zoster virus (VZV) infection. A primary infection with VZV results in chickenpox. After the primary infection, VZV can travel along the sensory nerves and remain dormant in the nerve root ganglion. The reactivation of VZV in ganglia may happen frequently but remains subclinical most of the time. In patients with immunosuppression or age-related immunosenescence, it can result in the clinical disease of HZ. Involvement of trigeminal nerve is common. Any branch of the trigeminal nerve can be affected and at times, more than one branch can be involved. Involvement of ophthalmic branch is serious due to the involvement of the eye and may result in blindness unless early treatment is carried out. Rarely, HZ may involve the sensory branch of the facial nerve. When the facial nerve is involved, it is referred to as Ramsay Hunt syndrome. Clinically there is an erythematous vesicular rash on the external ear (zoster oticus) or in the posterior mouth together with facial nerve palsy. Antiviral therapy is indicated in HZ to minimize the complications and to improve healing of the rash. Acyclovir is the drug of choice. Post-herpetic neuralgia (PHN) is the most important, common and troublesome complication of HZ. Prevention of PHN is very important in the management of HZ.