Varicella Zoster Virus Infection: Clinical Features, Molecular Pathogenesis, Treatment, and Prevention

Varicella zoster virus (VZV) is a ubiquitous human herpesvirus that establishes lifelong latency and causes herpes zoster (HZ) upon reactivation, posing a growing clinical challenge in aging populations. The incidence of HZ increases sharply with age and immunocompromised states, and its clinical burden extends well beyond cutaneous disease to include postherpetic neuralgia, neurological complications, and systemic involvement. At the mechanistic level, HZ reflects a dynamic interplay between viral reactivation, host immune surveillance, and virus-induced neuronal injury. Despite substantial progress in antiviral therapy and vaccination, many interventions remain focused on individual stages of the disease process, and the translation of molecular insights into comprehensive clinical strategies remains incomplete. In this review, we synthesize current knowledge of VZV epidemiology, structure, and life cycle, and provide an integrated overview of clinical manifestations and molecular pathogenesis, with particular emphasis on latency, reactivation, and immune evasion. We further summarize advances in diagnostic technologies and discuss therapeutic strategies targeting viral replication, inflammatory complications, and long-term sequelae, alongside preventive approaches. By linking disease mechanisms with clinical management, this review highlights key challenges and emerging directions for improving the prevention and treatment of HZ and provides a framework for translating fundamental discoveries into more effective interventions.