Herpes zoster (HZ), commonly known as shingles “kenali cacar api”, is the clinical manifestation of latent Varicella-Zoster Virus (VZV) reactivation. The virus remains dormant in the dorsal root ganglia following a primary varicella (chickenpox) infection during childhood or adolescence.
Although generally self-limiting, herpes zoster can lead to significant morbidity, particularly among elderly and immunocompromised individuals, due primarily to the risk of postherpetic neuralgia (PHN).
What Is Shingles ?
Shingles “kenali cacar api” occurs when dormant VZV is reactivated, often years after the resolution of the primary varicella infection. Once active, the virus travels along peripheral nerves to the skin, producing a painful, vesicular rash limited to one side of the body along a dermatomal distribution.
Epidemiology & Reactivation Triggers
Approximately 30% of the population will develop shingles “kenali cacar api” in their lifetime; the risk increases to >50% in individuals aged ≥85 years.
Reactivation is driven by declining cell-mediated immunity due to aging (immunosenescence) or immunodeficiency (e.g., cancer, organ transplant, HIV, diabetes mellitus, severe stress).
Shingles “kenali cacar api” is not transmitted person-to-person. However, direct contact with active vesicles can cause primary varicella in seronegative individuals.
Clinical Manifestations of Shingles
1. Prodromal Phase (2–5 days before rash)
- Unilateral neuralgia (sharp/burning/stabbing pain), paresthesia, or hyperalgesia.
- May include mild systemic symptoms: low-grade fever, malaise, headache.
2. Active Phase
- Evolution of maculopapular → vesicular → pustular rash, localized to a single dermatome (commonly thoracic, cervical, or cranial).
- Vesicles contain clear fluid that becomes cloudy, dries, and forms crusts within 7–10 days.
- Classic hallmark: unilateral rash not crossing the midline.
- Resolution Phase & Complication Risk
- Rash usually resolves within 2–4 weeks.
- However, 10–20% of elderly patients may develop persistent PHN lasting more than 3 months and potentially for years.
Clinical Complications
1. Postherpetic Neuralgia (PHN)
- Chronic neuropathic pain in the affected dermatome.
- More prevalent in patients aged ≥60 and those with severe acute-phase pain.
2. Herpes Zoster Ophthalmicus (HZO)
- Involves the ophthalmic branch (V1) of the trigeminal nerve.
- May cause keratitis, uveitis, and permanent vision loss if untreated.
3. Ramsay Hunt Syndrome
- Involves cranial nerves VII (facial) and VIII (vestibulocochlear).
- Presents with peripheral facial paralysis, vesicles in the external auditory canal, tinnitus, hearing loss, or vertigo.
4. Disseminated Zoster
- Usually in immunocompromised patients.
- 20 vesicular lesions outside the initial dermatome; may involve visceral organs (e.g., pneumonitis, hepatitis, encephalitis).
Management of Shingles
1. Antivirals (Initiated within 72 hours of rash onset)
Goal: Accelerate lesion resolution, reduce pain duration, and lower risk of PHN and complications.
First-line options:
- Acyclovir: 800 mg 5x/day for 7–10 days
- Valacyclovir: 1000 mg 3x/day for 7 days
- Famciclovir: 500 mg 3x/day for 7 days
- Valacyclovir and famciclovir are preferred due to better adherence and lower GI side effects.
2. Pain Management
- NSAIDs or paracetamol for mild pain
- Gabapentin, pregabalin, or tricyclic antidepressants (e.g., amitriptyline) for neuropathic pain
- Consider topical lidocaine patches or capsaicin for localized relief
3. Corticosteroids
- Reserved for select severe cases (e.g., HZO or disabling pain)
- Should always be combined with antivirals; use cautiously with comorbidities
Prevention Strategies
- Lifestyle Measures
- Balanced nutrition
- Regular physical activity (≥150 minutes/week)
- Adequate sleep (7–8 hours/day)
- Smoking cessation
- Routine medical check-ups to screen for risk factors
- Vaccination
Herpes Zoster Vaccine (HZV): one or two doses depending on vaccine type
Indications:
- All adults aged ≥50 years, especially with a history of HZ or comorbidities
- Immunocompromised patients (vaccine type to be selected appropriately)
Conclusion
Clinical management of Shingles “kenali cacar api” requires a comprehensive approach—beginning with prompt diagnosis based on clinical findings, early initiation of antiviral therapy, and individualized pain management strategies using systemic, topical, and sometimes interventional methods.
Corticosteroids may be considered for selected severe cases, and preventive vaccination plays a critical role in reducing incidence and complications in at-risk populations.
Holistic prevention also includes healthy lifestyle practices and regular screening shingles “kenali cacar api”. Cross-disciplinary collaboration and patient education are essential to optimize clinical outcomes and maintain long-term quality of life.
References
- Gagliardi AMZ et al. Vaccines for preventing herpes zoster in older adults. Cochrane Database, 2019.
- Indonesian Dermatology Association – Clinical Practice Guidelines on HZ, 2023.
- Strezova A, et al. Open Forum Infect Dis. 2022;9(10):ofac485.
- CDC. Shingles Vaccine Recommendations. 2024.
- Patil A, Goldust M, Wollina U. Viruses. 2022;14(2):192.
- Cunningham AL, et al. N Engl J Med. 2016;375(11):1019–32.
- PAPDI. Adult Immunization Schedule; 2025.
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