General practice & primary care · UKMLA & AKT
Shingles (Herpes Zoster)
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Prodrome (2-3 days before rash): burning/stabbing pain, hyperaesthesia localised to a single dermatome - often misattributed to MSK or cardiac causes
- Rash: erythematous macules/papules → vesicles → pustules → crusting, strictly unilateral, does not cross midline
- Distribution: thoracic dermatomes (T1-L2) most common
- Herpes zoster ophthalmicus (HZO): ophthalmic division (V1) of trigeminal nerve - periorbital vesicular rash, eye pain, redness, reduced visual acuity; Hutchinson's sign (vesicles on tip/side of nose) indicates nasociliary branch involvement and predicts intraocular complications
- Ramsay Hunt syndrome: geniculate ganglion (CN VII) - ipsilateral LMN facial palsy, vesicles in external auditory canal/soft palate, sensorineural hearing loss/vertigo
- Clinical diagnosis - do not wait for rash to initiate treatment if suspicion is high
Shingles in a young adult (<50) without obvious cause should prompt HIV testing - it is an HIV indicator condition.
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