JMS Pearce
Hull, England

The physician Aretaeus of Cappadocia in the second century AD described a painful skin eruption that typically followed a band-like or “girdle-like” pattern, which corresponds to the dermatomal pattern of shingles.¹ The Greek word herpein means “to creep,” and zoster (Latin cingulum) means a girdle or belt, referring to the rash’s unilateral nerve root distribution. Herpes zoster historically was often related to erysipelas and to St. Anthony’s fire.

Shingles

The earliest mention of shingles cited by the Oxford English Dictionary is in a medieval encyclopedia by Bartholomaeus Anglicus (1398):

Aȝeins ycchyng and scabbes wete and drye, and aȝeins þe schingles

In a medical context, the first known use of “shingles” is often credited to the English physician William Heberden who gave an unmistakable description in 1767²:

And post-herpetic neuralgia:

Richard Bright in 1831 associated the characteristic distribution of the rash with segmental nerves,³ and first located the pathology of herpes zoster (cases CCXLVII and CCXLVIII, p. 503) in the dorsal root ganglion.

In 1862, Von Barensprung also demonstrated at autopsy inflammatory lesions in the dorsal root ganglia and the sensory afferent nerves.⁴ Head and Campbell reported 450 cases and 21 autopsies to establish conclusively the pathology of zoster from which they mapped the segmental dermatomes.⁵ The varicella-zoster virus (VZV) was not identified until Weller’s work in 1953.^6,7

Varicella–zoster virus reactivation

Von Bokay first described the relationship between chickenpox and herpes zoster in 1892⁸ and more fully in 1909. The chickenpox varicella–zoster virus (VZV) establishes a latent infection in dorsal root ganglia for the entire life of the host. Reactivation of VZV^9,10 results in herpes zoster¹¹ and its neurological complications.^12,13 Reactivation is usually a single event which tends to appear in people over fifty or results from immunosuppression of cell-mediated immunity. In 1953, Thomas H. Weller proved the association between chickenpox and shingles by isolating the varicella-zoster virus in cell cultures.¹⁴

The varicella–zoster virus DNA has subsequently been shown by the polymerase chain reaction in blood vessels, CSF, and other tissues.

Complications

In elderly patients, shingles may be complicated by postherpetic neuralgia (intractable stabbing, burning pain, allodynia, and hyperalgesia persisting after four months). Less common sequelae are cerebral vasculopathy,¹⁵ myelitis, meningoencephalitis, ocular, and radicular motor weakness.¹² Rare cases without observed vesicles are described as “zoster sine herpetica.” James Ramsay Hunt described herpes zoster oticus in 1907.¹⁶ It is characterized by severe pain with vesicles in the external auditory canal or pinna, facial palsy with loss of taste in the anterior two-thirds of the tongue and variable tinnitus, deafness, and vertigo.

References

1. Adams F (trans). Aretaeus of Cappadocia: The Extant Works of Aretaeus the Cappadocian. Sydenham Society, 1856.
2. Heberden William (posthumous trans). Commentaries on the History and Cure of Diseases. Boston: Wells and Lilly, 1818: 101-2. Wellcome Collection. https://wellcomecollection.org/works/vkngqvxf
3. Bright R. Reports of Medical Cases, vol 2, no. 1. London: Longman, Rees, Orme, Brown, and Green: 383.
4. Cited by Sharpe N: Von Barensprung. Herpes zoster of the cephalic extremity, with a special reference to the geniculate, auditory, glossopharyngeal, and vagal syndromes. The American Journal of the Medical Sciences 1915;149:725-36.
5. Head H, Campbell AW. The pathology of herpes zoster and its bearing on sensory localization. Brain 1900;23:353-529.
6. Weller TH. Historical perspective. In: Arvin AM, Gershon AA, eds. Varicella-Zoster Virus: Virology and Clinical Management. Cambridge University Press, 2000:9-22.
7. Hyman, RW, Ecker JT, Tenser RB. Varicella-zoster virus RNA in human trigeminal ganglia. The Lancet 1983;322:814-6.
8. Von Bokay J. Uber den atiologischen Zusammenhang der Varizellan mit gewissen Fallen von Herpes Zoster Wien Zlin Wochenschr 1909;22:1323-6. [Bokay’s first paper Hungarian paper was published in 1892, cited by Weller TH.⁶]
9. Hope-Simpson RE. The nature of herpes zoster: A long- term study and a new hypothesis. Proc Roy Soc Med. 1965;58:9-20.
10. Kennedy PGE. Varicella-zoster virus latency in human ganglia. Rev Med Virol. 2002;12:327-34.
11. Kennedy PG, Steiner I. A molecular and cellular model to explain the differences in reactivation from latency by herpes simplex and varicella-zoster viruses. Neuropathol Appl Neurobiol. 1994;20(4):368-74.
12. Gilden DH et al. Neurologic complications of the reactivation of varicella-zoster virus. New Engl J Med. 2000;342:635-45.
13. Lenfant T et al. Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid. Brain and Behavior 2022;12:e2455.
14. Weller TH. Serial propagation in vitro of agents producing inclusion bodies derived from varicella and herpes zoster. Proc. Soc. Exp. Biol. Med. 1953;83(2):340-6.
15. Gilden D et al. Varicella zoster virus vasculopathies: diverse clinical manifestations, laboratory features, pathogenesis, and treatment. Lancet Neurol. 2009;8(8):731-40.
16. Hunt JR. On herpetic inflammations of the geniculate ganglion: a new syndrome and its complications. J Nerv Ment Dis. 1907;34:73-96.