• Title: Herpes Zoster: Pathogenesis, Clinical Features, and Management review article
  • Mahdieh hasanlo,1 Saman Hakimian,2,*
    2. Phd. student of Microbiology ,Biology department , Islamic Azad University Central Tehran Branch, Tehran , Iran


  • Introduction: Introduction: Herpes zoster (HZ), commonly known as shingles, is a debilitating disease caused by the reactivation of latent varicella-zoster virus (VZV) within the dorsal root or cranial nerve ganglia. Following primary infection, typically manifesting as varicella (chickenpox) during childhood, the virus establishes lifelong latency in sensory neurons. Under conditions of immune senescence or immunosuppression, the virus can reactivate, leading to HZ. HZ represents a substantial public health concern worldwide. Nearly one-third of individuals are estimated to develop HZ during their lifetime, with incidence increasing markedly after the age of 50. Immunocompromisedpopulations, including patients with malignancies, HIV infection, or those undergoing immunosuppressive therapies, are at particularly high risk. Globally, millions of new cases occur annually, and with increasing life expectancy, the burden of HZ is expected to grow.
  • Methods: Material methods: Global studies indicate that the annual incidence in the general population ranges from 3 to 5 cases per 1,000 person-years, whereas in older adults, this can rise to 8–12 per 1,000 person-years (ScienceDirect, 2025). Some evidence suggests women may have a slightly higher risk than men, although findings are inconsistent (PubMed Central, 2023). With an aging population and increasing prevalence of immunosuppressive conditions, the burden of HZ is expected to rise, emphasizing the importance of effective preventive strategies, including vaccination. HZ arises from reactivation of latent VZV residing in sensory ganglia, primarily the dorsal root or cranial nerve ganglia. After primary infection, usually in childhood as varicella, the virus remains dormant for decades. Reactivation occurs when cell-mediated immunity declines due to aging, immunosuppressive therapy, or underlying immunodeficiency.
  • Results: Results: HZ usually begins with a prodromal phase characterized by vague pain, burning, itching, or tingling in a specific dermatome, lasting 2–5 days. Subsequently, painful vesicular eruptions appear, typically unilateral and confined to a single dermatome. Lesions evolve from erythematous macules to papules and then vesicles, which crust over within 7–10 days. In some patients, lesions may be complicated by hemorrhage or secondary bacterial infection.   Pain associated with HZ can persist after rash resolution, leading to PHN. Severe cases may involve ocular tissues (herpes zoster ophthalmicus) or the central nervous system, resulting in meningitis or encephalitis. Some patients may also experience long-term sensory or motor neuropathies.
  • Conclusion: Conclusion: Herpes zoster (HZ) continues to pose a substantial public health challenge worldwide, particularly affecting older adults and individuals with compromised immune systems. The disease not only causes acute pain and discomfort but can also lead to long-term complications such as postherpetic neuralgia, significantly impacting patients’ quality of life. While current antiviral therapies provide effective management of acute infections and vaccines offer preventive benefits, limitations remain in achieving universal coverage, optimal timing of vaccination, and management of severe or atypical cases.
  • Keywords: Herpes zoster; Shingles; Varicella-zoster virus; Aging; Vaccination;