A Short Review and Update on Epidemiology, Treatment, and Management of Herpes Zoster (Shingles) Infection

Herpes zoster, also known as shingles, is caused by the reactivation of the Varicella-Zoster Virus (VZV), which remains dormant in the cranial sensory nerve ganglia and spinal dorsal root ganglia after the initial VZV infection is cured in a patient. When it reactivates, it travels down the nerve to the skin, causing a painful rash and blisters. The pathophysiology involves viral replication in nerve cells, inflammation, and subsequent skin lesions. Herpes zoster can have a significant impact on an individual's physical, psychological, and social well-being. While the condition is usually not life-threatening, it can cause painful and debilitating complications. Herpes zoster can cause significant morbidity, primarily due to Postherpetic Neuralgia (PHN), a persistent neuropathic pain condition. While acute pain during the initial HZ rash can be intense, PHN can be debilitating and significantly impact a patient's quality of life. Other complications, though less common, can include vision loss, neurological problems, and secondary bacterial infections. Herpes zoster (HZ), which has a lifelong risk of 20 to 30% that rises with age, is a prevalent disease in the elderly and immunocompromised patients and leads to increased healthcare costs. The primary goals of HZ management are to minimize and prevent Postherpetic Neuralgia (PHN) and Zoster-Associated Pain (ZAP), as well as to promote a speedy recovery from the viral infection. The treatment of infection requires the use of antivirals that combat viral replication. However, only a few antivirals, such as acyclovir, famciclovir, valacyclovir, amenamevir, and brivudine, have clinical licenses for the treatment of HZ. Thankfully, several novel HZ medications have been proposed and studied, including new antivirals that target various Herpesviridae species. Regular immunization with available vaccines has demonstrated a significant impact on lowering the incidence of HZ and PHN in people over 60 years of age. This article reviews the etiology, epidemiology, pathophysiology, clinical features, evaluation, and available treatments and vaccines for the management of HZ infection, using articles and reviews available in public databases to date (PubMed, Scopus, Embase, and manual searches of Google Scholar). In addition, the differences in safety and effectiveness between the antivirals that are currently licensed for the treatment of HZ, the potential use of novel antivirals in the future for treating HZ, and the antivirals' therapeutic or preventive effects on ZAP or PHN are also discussed.