Herpes zoster

Abstract

Diagnosis of herpes zoster is mostly a 'spot' one; its treatment is routine. But sometimes recognition presents a severe challenge, demanding knowledge of protean variations, meticulous data gathering and analysis, and recourse to several diagnostic approaches. There may be need for hypothesis testing, pattern completion, working through neuroanatomy and neurophysiology, even a vigilant 'wait and see' policy (without doing harm). Management, too, can impose much agonising. How far should we carry out investigations? In what sequence should we order them? When should we wheel out the big therapeutic guns? Even straightforward cases call for that basic general practice competence - communication. The anxieties and expectations of patient and family have to be anticipated and elicited. Technical information must not only be given but given effectively and we must reach informed agreement on treatment and precautions.