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What is Herpes Zoster or Shingles?
Herpes Zoster or "shingles"
is the return of the varicella (chicken pox) virus. After an infection
with Chickenpox, the virus migrates along the nerve, enter the neuronal
sensory ganglion cells, penetrate the nucleus and remain as a part of
the chromosome!
Due to some unknown stimulation or
lowering of immunity , the virus comes back with vengeance along
the nerve distribution on the skin.
What are the signs and symptoms of
Herpes zoster?
The skin eruption in shingles consists of painful
and or /itchy vesicles, which follow a unilateral (one side of the body),
dermatomal (supplied by a single nerve branch) distribution. Before the
eruption starts, the patient may feel a prodromal symptom of pain or burning
sensation on the skin or from inside the body (inside because the same nerve
may be supplying internal organs also. This is know as referred pain).After 1-2
days of the pain, a red belt like(hence the name fire belt or hell fire)
eruption occur along the nerve distribution.
The entire course of herpes zoster lasts 2-3
weeks, depending upon the patient's immune status and whether or not he/she has
taken treatment early in the course of the disease.
Any part of the body may be involved, the most
common being the trunk (thoracic nerves), followed by the head (first branch of
trigeminal nerve).
Who Gets Shingles?
Any one who has had chickenpox earlier can
develop herpes zoster later in life. However, it usually develops in persons
above the age of 50 years. The disease is more prevalent among the
immune-deficient individuals, like those suffering from HIV infection.
Can Herpes be recurrent?
Usually no. But it has been noted that around 5%
of persons can get recurrent attack, usually in the same place.
What is Disseminated Herpes zoster?
When there are more than 20 vesicles elsewhere in
the body outside the normal dermatomal distribution, it is considered as a
disseminated or generalized Herpes Zoster. This is an indication for further
investigations to rule out underlying immune deficiency caused by diseases like
HIV or malignancies(cancers).
Is Herpes zoster contagious?
Persons coming in direct contact with herpes
zoster do not develop herpes zoster, but may contract chicken pox after about
10-14 days, if they have not had chicken pox earlier.
But, herpes zoster is not as infectious as
chicken pox is (Remember, chicken pox can get transmitted through the
respiratory route also).
Is there any complication after Herpes?
Post herpetic neuralgia(PHN) is the most
feared complication of herpes zoster. In around 10-15% of cases of herpes
zoster, patients continue to feel pain along the nerve distribution even after
the skin lesions have healed, hence the name "post" herpetic. Sometimes the
pain is very severe and debilitating. Incidence of PHN increase dramatically
with increase in age and patients aged 60 and above has a 50% of developing PHN
after an attack of shingles. Other neurological and eye complications may also
occur in severe herpes zoster
How is Herpes zoster managed?
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For mild cases:
Herpes zoster is a self limiting disease and
usually only require cool compresses, antihistamins and antiinflammatory drugs.
Silver sulfadiazine cream is particularly effective as a topical application.
However, systemic therapy is advised, if,
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Age above 50 years
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Patient has an underlying debilitating disease
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The lesions involve the face near the eyes
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The lesions involve a larger area and the
prodromal pain is severe
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Systemic treatment is given with acyclovir or
famcyclovir
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Should be started before 48 hours of onset of
symptoms preferably. After 72 hours, the medication does not alter the course
of diseases.
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For those at risk of developing PHN(age
>60,immune deficient),an initial course of systemic steroid is advised by some,
but other schools of study has proven otherwise.
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Post herpetic neuralgia is managed with trycyclic
antidepressants,coolant sprays, capsaicin ointment, trans-cutaneous electric
nerve stimulation, and in very severe pain, even surgical intervention to cut
off the neural pain transmission.
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Dr.Hanish Babu, MD
