Herpes Zoster (Shingles)

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Is an infection that results when Varicella-zoster virus reactivates from its latent state in the posterior dorsal root ganglion.

Signs and symptoms

  • Pre-eruptive pain, itching or burning: generally localized to the dermatome, precedes the eruption by 4-5 days.
  • Followed by characteristic crops of very painful vesicles on the dermatome
  • Multi-dermatomal and disseminated forms may occur in immunocompromised states, especially in HIV infection
  • Mild chills, fever, malaise, headache etc.

Differential diagnosis

  • Chickenpox

Complications

  • Pain may persist long after rash has healed (post herpetic neuralgia)
  • Dissemination of infection in the immunocompromised
  • Haemorrhagic and necrotic lesions

Investigations

  • Diagnosis is clinical
  • Serology test for HIV

Treatment objectives

  • Manage the infection
  • Prevent complications

Pharmacological treatment

Symptomatic and supportive treatment

Clean lesions with antiseptic, e.g. chlorhexidine solution 0.05%

Or diluted hydrogen peroxide solution 6%

Apply calamine lotion 2–3 times daily

For neuropathic pain

Amitriptyline oral

25 mg nocte,

OR

Carbamazepine oral  

200 mg nocte as necessary

Acyclovir oral

800 mg 5 times a day for 7-10 days can be given, especially if the disease is diagnosed very early or is disseminated

Prevention

  • Protect high-risk individuals (e.g. the immunosuppressed) from direct contact with the disease

If the lesions involve the eye

  • Refer to an ophthalmologist (Eye Specialist)