Presentation and management of herpes zoster (shingles) in the geriatric population.

INTRODUCTION Infection with varicella zoster virus (VZV) was first documented in the writings of ancient civilizations as a vesicular rash of unknown causes. A relationship between herpes zoster and chickenpox was suggested in 1888 and was finally proven in the 1950s. Since then, much progress has been made in preventing and treating the disease with the introduction of a live attenuated vaccine in 1974, treatment with acyclovir (Zovirax, Valeant) in the 1980s, and complete DNA sequencing in 1986, all of which may ultimately lead to the eradication of VZV infection.1 The infection usually presents as two distinct entities: chickenpox (the primary infection) and herpes zoster (also known simply as zoster), a secondary condition. Primary VZV infection typically manifests in children as chickenpox, a seasonal viremia that tends to occur in epidemics. Chickenpox is characterized by a generalized rash that begins as maculopapular lesions and progresses to vesicles that spread to the extremities, accompanied by fever.2 It is highly contagious but is usually benign.3 After the vesicles begin to form scabs, the lesions stop releasing virus and the contagious nature of the infection is reduced. Adults tend to be more seriously ill than children, and they experience more complications.4 Before the use of pediatric vaccines in the U.S., more than 90% of Americans had chickenpox before the age of 20.3 After a VZV infection resolves and immunity develops, latent virus persists in the dorsal root ganglia.5 This article provides an overview of herpes zoster (shingles), with an emphasis on its potential complications, management, and prevention in the elderly population.