Herpes zoster (shingles)

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CLINICAL DESCRIPTION

After an episode of chicken pox, the varicella zoster virus will remain in the body within nerves but kept inactive by one’s immune system. A reactivation of this varicella zoster virus may occur at any time later on, leading to inflammation of the dermatome supplied by the nerve.

Causes: Varicella Zoster virus

  • Populations at risk are those immunosuppressed due to HIV infection, old age, other immunosuppressive medication, diabetes and many others.
  • Any dermatome may be affected by commonly affected ones include thoracic, trigeminal, cervical and sacral dermatomes.

CLINICAL FEATURES

SIGN AND SYMPTOMS
  • Tingling burning sensation or painful skin along a dermatome.
  • Painful vesicles, on an erythematous base, which later develop blisters or erosions.

TREATMENT

  • Give Acyclovir 800mg 5 times a day for 5-7 days; best clinical outcome is if initiated within 24 -72 hours from onset of the lesions.
  • Apply calamine lotion on intact lesions for their fast drying.
  • Give analgesics and carbamazepine for pain relief
  • For ophthalmic herpes zoster treat as above and refer to eye department urgently.
  • If status not known, refer for HIV testing for any patient regardless of age and underlying medical risk factors.

NOTE: In the HIV immunosuppressed patients, continue treatment with acyclovir until all lesions have healed.