Shingles (Herpes Zoster): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate herpes zoster (shingles):

Prodromal stage (early phase of disease in which nonspecific symptoms occur; about 5 days): First, nonspecific general symptoms (fatigue, impaired performance, fever, and aching limbs) occur. Then local pruritus (itching) and paresthesias (sensory disturbances). Then appearance of typical zoster vesicles (herpetiform vesicles; centrally forked, usually < 5 mm) on erythema (skin redness). Leading symptoms

  • Pain in the affected dermatome (segmental skin area innervated by a spinal cord nerve; see “Common localizations” below); may occur before skin symptoms.
  • Exanthem (rash) with formation of zoster vesicles (also possible without efflorescence) in the affected dermatome (strictly unilateral); from the vesicles develop pustules, which dry up after about 1 week (crust formation) and fall off in the following 2 weeksSpecial case: necrotic or hemorrhagic zoster (usually in the head and neck area) leaves behind scars

Common localizations [guideline: S2k]

  • Thoracic dermatomes (segmental skin area innervated by a spinal cord nerve: here: Thoracic region) (55%).
  • Supply area of the trigeminal nerve (20%).
  • Lumbar dermatomes (here. area of the lumbar spine) (13%).
  • Cervical dermatomes (here: area of the cervical spine) (11 %)
  • Sacral dermatomes (here: area of the sacrum) (2 %)

In rare cases, a herpes duplex develops, i.e. the zoster vesicles cross the midline.Generalization is possible in rare cases (especially in immunodeficiency)!

Other possible localizations of herpes zoster are:

  • Zoster ophthalmicus – face and eyes are affected (Cave! Scarring of the cornea (cornea of the eye)).
  • Zoster oticus – the auditory canal is affected.
  • Zoster maxillaris – the jaw is affected
  • Zoster genitalis – zoster in the genital area.

Later, postherpetic neuralgia (PHN) may develop. The frequency for this is about 8-20%. The following symptoms and complaints may indicate postherpetic neuralgia (PHN):

  • Pain lasting longer than 30 days or persisting longer after the skin lesions of herpes zoster have healed
  • Pain or discomfort presents in the following manner:
    • Constant, dull pain (continuous pain), which is felt as a sharp burning or stabbing pain.
    • Occurrence of the pain together with paresthesias (misfeelings), dysesthesias (painful or otherwise abnormal sensation), or allodynia (increased sensitivity to pain)
  • Neuropathic itching (due toloss of sensory neurons as a result of zoster).