Herpes Zoster (Shingles)
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An acute cutaneous infection involving primarily the dorsal root ganglia, usually of a single dermatome. It is characterised by a vesicular eruption in areas supplied by peripheral sensory nerves in the affected root ganglia.
Cause
- Varicella zoster virus, usually reactivated from the virus that entered the cutaneous nerves during an earlier episode of chicken pox and remained in a latent form. This usually occurs during low immunity.
- For chickenpox, see Chickenpox
Clinical features
- Pre-eruptive pain, itching or burning: generally localized to the dermatome, precedes the eruption by 4-5 days
- The above are followed by characteristic crops of very painful vesicles on the side supplied by affected nerve
- Mild chills, fever, malaise
Differential diagnosis
- Chicken pox
- Herpes simplex
Investigations
- Clinical diagnosis is sufficient
- Serology test for HIV, if sero-status not known
ManagementTreatment
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
- Analgesics for neuropathic pain e.g. amitriptyline 25 mg nocte, or carbamazepine 200 mg nocte as necessary
- Oral aciclovir 800 mg 5 times a day for 7 days can be given, especially if the disease is diagnosed very early or is disseminated
If the lesions involve the eye
- Refer to an ophthalmologist (Eye Specialist)
Prevention
- Protect high-risk individuals (e.g. the immuno- suppressed) from direct contact with the disease