An acute unilateral inflammation and infection of the dorsal root ganglia; also called shingles.

Herpes zoster is caused by infection with the herpesvirus varicella-zoster (V-Z). This is the same virus that causes chicken pox. Shingles occurs after reactivation of the herpesvirus V-Z that has been dormant since a previous episode of chicken pox. The virus is primarily spread from one person to another by the respiratory route, but it can also spread by contact with secretions from the skin lesions.

Herpes zoster produces localized vesicular lesions which are confined to skin areas supplied with nerve fibers conducting impulses to the spinal cord by single posterior roots (dermatomes). Severe neuralgic pain develops in the peripheral areas innervated by the nerves arising in the inflamed ganglia. Other symptoms include

• fever,

• malaise,

• pruritus, and

• paresthesia or hyperesthesia, usually on the trunk.

The vesicles spread unilaterally around the thorax or vertically over the arms and legs, and fill with clear fluid or pus. Approximately 10 days after they appear, the lesions dry, and form scabs. Occasionally, cranial nerve involvement of the face develops.

Usually, physical examination of the lesions with the dermatomic distribution is enough to confirm diagnosis. A Tzanck test of the fluid from the vesicles and infected tissue, and biopsy and viral culture may also be performed to confirm the diagnosis.

Treatment may consist of medications to relieve the itching and severe neuralgic pain, such as

• calamine lotion or another topical antipruritic;
• aspirin, possibly with codeine or another analgesic; and
• occasionally, tincture of benzoin may be applied to unbroken lesions.

If the lesions have been infected with bacteria, treatment may include an antibiotic. Two medications that may be used in the treatment of shingles include:

• acyclovir (Zovirax) which may stop the progression of the skin rash and prevent visceral complications; and
• vidarabine (Vira-A) which may speed up the healing process of the lesions, decrease pain, and prevent spread of the condition and the development of complications.

Lesions of herpes zoster, shingles, will heal and resolve. However, the patient may have postherpetic neuralgia that may last for months or even years. Shingles can be debilitating in the presence of a weakened immune system, and a small number of patients may experience recurrence of the condition.

• When 38 CFR 4.118 offers variable methods to evaluate a skin condition, assign a single evaluation using the criteria that results in the highest rating. 

• Consider this condition pursuant to 38 CFR 4.27 and 38 CFR 4.20, when applicable. Analogous ratings are utilized when a specific disability is not listed in 38 CFR Part 4. Certain hyphenated codes do not necessarily denote analogous ratings – a hyphenated DC may also be used to identify the proper evaluation of a disability or a residual from disease. Diagnostic Codes (DCs) must be carefully selected as a condition specifically listed in the rating schedule may not be rated by analogy, unless otherwise directed (e.g., amyotrophic lateral sclerosis, multiple sclerosis).  When multiple DCs apply to a given disability, consider whether separate evaluations are warranted, and/or which DC will result in the most advantageous outcome for the claimant.

Notes

• 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin. 

• 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.