Shingles

Herpes Zoster

What is Shingles?

Shingles is a viral disease that can occur long after a chickenpox infection, at which time a portion of the virus (varicella zoster virus VZV) becomes dormant in nerve cells. Under suitable conditions like stress, trauma, or weakened immunity, the virus can become reactivated and cause a new skin infection, usually on the trunk. If shingles occurs, most people have only a single attack in their lifetime. Shingles is much less contagious than chickenpox. But, the pain associated with shingles can persist for months after the skin blisters disappear, in contrast to the prompt resolution of chickenpox.

How is it diagnosed?

History is of an exposure/infection to chickenpox in the past. Typically, the first symptom is a burning sensation or hypersensitivity to touch (the prodromal phase), on one side of the body. Often a slight fever and headache accompany this phase. Three or four days later, a red rash appears on the trunk (n three-quarters of cases) and/or the face.

Physical exam will show the appearance of small blisters following the skin rash. The rash commonly appears in a band on one side of the trunk on one side of the face, following the nerve supply to that area (dermatomal pattern) or on one buttock. When the face is involved, the cornea and eye tissues can become inflamed. Blisters last two to three weeks, they ooze pus, and then crust over and heal.

Tests: Blood tests or culture of the virus from early lesions may confirm VZV infection.

How is Shingles treated?

The rash associated with shingles is treated symptomatically using painkillers, anti-inflammatory drugs, and cool compresses, which help dry the blisters. Isolation of the individual is usually not necessary. Because shingles occurs often in individuals with impaired immunity, the infection must be monitored closely for any sign of complications.

When the individual is very ill or suffering from involvement of the eyes or brain, antiviral drugs such as nucleoside analogs may be used; these drugs interfere with the growth of VZV. To be effective, treatment with nucleoside analogs must begin very early in the infection. Such treatment reduces the appearance of blisters and the duration of the infection but may not affect the persistent pain (neuralgia) which is present when the blisters heal. Extreme cases of neuralgia are treated with narcotic painkillers during the day and tranquilizers at night.

Medications

Information Brand Generic Label Rating
http://www.nmihi.com/a/acyclovir.html Zovirax Acyclovir On-Label
http://www.nmihi.com/a/amitriptyline.html Elavil Amitriptyline Off-Label

Famvir (Famciclovir), Valtrex (Valacyclovir)

What might complicate it?

Persistent pain after the skin infection is seen in ten percent of individuals under 40 years of age, increasing to 20% to 50% of those over 60. When there is facial involvement, temporary paralysis of the face, or damage to the cornea with blindness can result. In individuals with severely impaired immune systems, shingles infrequently results in a widespread infection of the skin, internal organs, or the brain.

Predicted outcome

The prognosis is good with occasional post-herpetic neuralgia.

Alternatives

Shingles is not likely to be confused with chickenpox or other herpesvirus infections, due to the one-sided distribution of blisters in a band. Before the eruption of blisters, the pain might resemble that with pleuritis, lumbago, or a degenerating vertebral disc.

Appropriate specialists

Dermatologist, internist, neurologist, anesthesiologist, and infectious disease specialist.

Last updated 27 May 2012


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