Herpes zoster, characterized by burning back pain and a band-like rash, is caused by the reactivation of the varicella-zoster virus. In anyone who had chickenpox during childhood, this virus does not disappear; instead, it lies dormant in the ganglion near the spinal cord (dorsal root ganglia), reawakening when the body's immunity falters. It behaves just like a long-dormant virus springing into action as if waiting for the right moment.
Once reactivated, the virus triggers inflammation and pain along the dermatome, which is the area of skin innervated by that specific nerve. Initially, prodromal symptoms such as pain, itching, and tingling occur without any rash; a few days later, red spots and blisters characteristically appear in a band-like pattern. These blisters gradually turn into pustules and crust over, resolving across two to four weeks, but the real challenge lies in the pain. Caused by nerve injury, this neuralgia is described as sharp, stabbing, cutting, or a burning sensation. It can even involve allodynia, where the lightest touch of clothing causes severe distress, significantly reducing a patient's quality of life.
The risk of onset is particularly high in individuals with decreased immunity, such as older adults, chronic disease patients, cancer patients, and those taking immunosuppressants. Extreme stress can also disrupt the immune system, promoting viral reactivation. Early diagnosis and treatment are crucial; administering an antiviral drug within 72 hours of symptom onset greatly helps suppress viral replication and prevent complications. If the treatment window is missed or nerve injury is severe, it can progress to postherpetic neuralgia, causing persistent pain that lasts for months or even years. Because herpes zoster around the eyes can cause vision loss and lesions around the ears can lead to facial palsy or hearing loss, seeking a prompt and accurate medical evaluation upon the slightest suspicion is essential. Getting vaccinated against herpes zoster is also a sensible preventative approach. We must listen carefully to this strong signal sounded by our nervous system and immune system.
