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Shingles (Herpes Zoster)

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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?

  • 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,

  • Age above 50 years

  • Patient has an underlying debilitating disease

  • The lesions involve the face near the eyes

  • The lesions involve a larger area and the prodromal pain is severe

  • Systemic treatment is given with acyclovir or famcyclovir

  • Should be started before 48 hours of onset of symptoms preferably. After 72 hours, the medication does not alter the course of diseases.

  • 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.

  • 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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Information on this site is provided for informational purposes and is not meant to substitute for the advice provided by your own dermatologist or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. Many skin diseases have similar morphology and may resemble one another. But their treatment varies. Hence, self diagnosis and treatment are not advised. In case of doubt always be on the safer side and consult your dermatologist. Your online dermatologist will give you special tips to deal with specific skin and cosmetic problems.

Information about each product is taken from the labels of the products or from the manufacturer's advertising material. Skin Care Tips From or Dr.Hanish Babu are not responsible for any statements or claims that various manufacturers make about their products. We cannot be held responsible for typographical errors or product formulation changes. You should read carefully all product packaging. If you have or suspect that you have a medical problem, promptly contact your health care provider. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. 

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