Herpes lumborum, in the case of herpes zoster, presents as clusters of blisters distributed in a band along one side of the nerve with painful discomfort. In younger patients it may be accompanied by itching discomfort without significant painful discomfort. Shingles is caused by varicella-zoster virus infection and may be preceded by flu-like symptoms. Some patients may first experience painful discomfort or itching in the lower back before the typical rash develops. The blisters are usually not over the midline and appear as clusters of blisters the size of a grain of rice to a bean, which break easily to form a vesicular surface. The main treatment is to give oral antiviral valacyclovir or famciclovir; at the same time can be combined with nerve-nourishing methylcobalamin and vitamin E oral; topical can be given penciclovir gel or povidone-iodine solution for external use.