Shingles

• Definition
· Shingles (Herpes Zoster) is the disease of the reactivation of dormant chicken pox virus.
· The Herpes Zoster virus is the third of eight different human herpes viruses that are responsible for infection ranging from genital herpes to infectious mononucleosis.

• Overview
· Shingles (Herpes Zoster) is an abrupt outbreak of vesicles (little blisters) in the skin.
· The outbreak looks very similar to primary chicken pox except it is localized to a smaller area, and only present on one side, not crossing the mid-line of your body.
· Pain at the site of the vesicular is usually present about two days before the blisters appear and usually persists after the rash.
· The vesicular rash most commonly occurs on the trunk, starting at the spine and wrapping around the chest of abdomen.
· Viral replication within the nerve causes pain.

• Types
· In immunocompetent patients, the immune system still functions normally with Herpes Zoster.

· People with an impaired immune system, HIV, and cancer do not form an adequate immune response to the infection and are at risk of the infection spreading.

• Symptoms
· Shingles causes an aching or sharp discomfort along the area of the rash which usually starts a couple of days before the rash and may persist after the rash. Patients may also have fever, fatigue and generalized myalgias (muscle aching).

• Complications
Post herpetic neuralgia is persistent pain at the site of the rash.

•Treatment
· Shingles is typically treated with anti-viral medications such as: Acyclovir, Famciclovir and Valacyclovir.

· Additonally, corticosteroids may decrease the risk of developing post herpetic neurology (persistent pain after the infection).

References
Dworkin RH et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007 Jan 1;44(Suppl 1):S1-S26. [PMID: 17143845]

Posted on December 25, 2008

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