Information About Herpes Zoster

Herpes Zoster also known as shingles, is caused by the varicella zoster virus, the same virus that causes chickenpox in children. it is an acute CNS infection involving primarily the dorsal root ganglia, and characterized by vesicular eruption and neuralgic pain in the cutaneous areas supplied by peripheral sensory nerves arising in the affected root ganglia.

Herpes Zoster Symptoms and signs

Prodromal symptoms of chills and fever, malaise and GI distrubances may be present for 3 or 4 days before distinctive features of the disease develope, with or without pain along the site of the future eruption. On about the 5th day, characteristic crops of vesicles on an erythematous base appear. The involved zone is usually hyperesthetic and the associated pain may be severe. The eruptions occur most often in thoracic region and spread in unilateral manner and begin to dry and scab about the 5th day after their appearance. On attack of herpes zoster ussually confers immunity. Most patients recover without residua, except for scarring of the skin. However, postherpetic neuralgia may persist for months or years. The most common symptoms of Herpes Zoster/shingles include:

•  Fever, headache, chills
• Painful, itchy skin that turns into a rash
• A rash of red, painful blisters
• Rash often occurs only on one side of the body
• Blisters that break open, then scab over

 

Diagnosis

Though difficult in the pre eruption stage, diagnosis is made readily after the vesicles appear in characteristic distribution. Pleurisy, trigeminal neuralgia, Bell's palsy and in children, chickenpox must be differentiated. Herpes simplex virus may produce nearly identical zosteriform lesions. Herpes Simplex tends to recur, but herpes zoster rarely ever does. The viruses can be differentiated by culture and serologically.

Treatment

Corticosteroid if given early may relieve pain in severe cases. The initial dose should relatively large and duration should not exceed 3 weeks. All the precautions associated with prescribing corticosteroids should be observed

Geniculate zoster :

results from involvement of the geniculate ganglion. There is pain in the ear and facial paralysis on the involved side, but facial paralysis rarely permanent. Vesicular eruptions are present in the external auditory canal and on the auricle, the soft palate and the anterior pillar of the fauces.

Ophthalmic Herpes Zoster

Ophthalmic Herpes Zoster will appear if the gasserian ganglion is affected. There pain and a vesicular eruption in the distribution of the ophthalmic division if the 5th nerve. A 3rd nerve palsy may be present. Vesicles on the tip of the nose indicate that the nasociliary branch of the 5th nerve and the cornea are involved, with probable ulcernations and opacities.