Ramsay Hunt

VZV reactivation presents with pain or paresthesias in a specific dermatome; the characteristic rash develops several days later. In order of frequency, the thoracic, trigeminal, lumbar, and cervical cutaneous dermatomes are most often involved. More than 50% of cases occur in persons older than 60 years; immunocompromised patients are also at risk.
Involvement of the geniculate ganglion may cause herpes zoster oticus, also known as the Ramsay Hunt syndrome
characterized by pain and vesicles in the external ear canal, ipsilateral peripheral facial palsy, and altered or absent taste. Patients may also experience hearing loss, tinnitus, and altered lacrimation.
Most experts consider Ramsay Hunt syndrome to be a polycranial neuropathy, with frequent involvement of cranial nerves V, IX, and X. A vesicular rash may be absent in patients with VZV (zoster sine herpete) and should not deter physicians from ordering polymerase chain reaction testing for VZV. Acyclovir is typically prescribed for this syndrome. The live attenuated zoster vaccine has 64% efficacy that decreases to 36% after 6 years. A novel recombinant zoster vaccine, approved in 2017, has 97% efficacy and should be given to this patient.

Shingles