ABHISHEK JHA

HERPES ZOSTER

Herpes zoster/shingles is a viral infection of the nerve cells and surrounding skin, caused by the varicella zoster virus that also causes chickenpox

After a person recovers from chickenpox infection, the virus remains dormant in the nerve cells and can reactivate at a later stage when the immune system is weakened

Reactivation can be associated with older age, having chickenpox before 18 month of age or immunosuppression

What is it??

Painful skin rash with blisters involving a limited area.

Typically the rash occurs on either the left or right of the body or face in a single stripe. Two to four days before the rash occurs there may be pain or tingling in the area.

Rash usually heals within two to four weeks. some people develop ongoing nerve pain which may last for months or years called post herpetic neuralgia.

Exposure to the virus in the blisters can cause chickenpox in someone who has not had it before but will not trigger shingles

NonspecificHeadache, fever and malaise

Specificsensations of burning pain, itching, hyperesthesia (oversensitivity) paresthesia "pins and needles".

Pain can be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.

Signs And Symptoms

Shingles in children is often painless, but people are more likely to get shingles as they age, and the disease tends to be more severe

Usually within a dermatome, a rash will begin to develop, often causing a pain, itching or tingling sensation in the area of the affected nerve

A fluid filled painful rash then develops a few days after and commonly occurs either on one side of the face or body

The rash forms blisters that typically scab over in 7-10 days and this eventually clears within 2-4 weeks.

Later the rash becomes vesicular, forming small blisters filled with a serous exudate, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, and crust over within seven to ten days; usually the crusts fall off and the skin heals, but sometimes, after severe blistering, scarring and discolored skin remain

The ophthalmic division of the trigeminal nerve is most commonly involved branch. When the virus is reactivated in this nerve branch it is termed zoster ophthalmicus. The skin of the forehead, upper eyelid and orbit of the eye may be involved.

Shingles oticus, also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness)

Due the close relationship of blood vessels to nerves, the virus can easily spread to involve the blood vessels and compromise the blood supply, sometimes causing ischemic necrosis

Pain radiating along the path of a single spinal nerve (a dermatomal distribution), but without an accompanying rash.

This condition may involve complications that affect several levels of the nervous system and cause many cranial neuropathies, polyneuritis, myelitis, or aseptic meningitis.

Other serious effects that may occur in some cases include partial facial paralysis (usually temporary), ear damage or encephalitis Prognosis

Typically resolves within 3–5 weeks, certain complications may arise:

Secondary bacterial infectionMotor involvement, including weakness especially in

"motor herpes zoster"Eye involvement: trigeminal nerve involvement (as seen in

herpes ophthalmicus) should be treated early and aggressively as it may lead to blindness. Involvement of the tip of the nose in the zoster rash is a strong predictor of herpes ophthalmicus.

Post herpetic neuralgia a condition of chronic pain following shingles.

1. Visual Examinationsrash in a dermatomal pattern

2. Laboratory testsIgM antibody in blood; this appears only during chickenpox or shingles and not while the virus is dormant

3. PCR

4. viral culture

Diagnosis

1. AnalgesicCalamine= an be used on the rash or blisters and may be soothing.Zostrix cream Once the lesions have crusted over, can be used.Morphine ,Topical lidocain reduce pain.

2. Antiviralacyclovir, valaciclovir

3 Steroidscorticosteroids for short term

Treatment