What is Herpes Zoster (Shingles)?
Herpes zoster is a viral infection characterized by a painful rash of blisters (water-filled vesicles) in a localized area supplied by a single nerve. It is the reactivation of the chickenpox virus in adulthood, called the Varicella virus.
Understanding Herpes Zoster
The herpes virus has a tendency to stay dormant in the nerve roots for years, even after chickenpox has resolved. The virus reactivates after a number of years. This reactivation generally happens when the immunity falls. Herpes Zoster is, therefore, a common ailment among the elderly, immunocompromised individuals or those taking immunosuppressant medication.
What are the causes and risk factors for Herpes Zoster?
Shingles is caused by the Varicella-zoster virus.
Risk factors include:
- Old age
- Immunocompromised states like
- HIV infection
- Anti-cancer therapy
- Steroid therapy
What are the symptoms of Herpes Zoster?
- Burning pain
- Rash distributed over the trunk or neck
- Painful blisters that appear as a single crop
- Itching, increased sensitivity of the skin, tingling sensations
The painful vesicles eventually become cloudy or dark due to bleeding. They remain for 7 to 10 days and the crusts fall off leaving behind scars.
- If the face is involved the trigeminal nerve is the most common cranial nerve to be affected. The condition is called herpes zoster ophthalmicus. It is characterized by conjunctivitis, keratitis, uveitis, and optic nerve palsy, causing loss of vision and debilitating pain.
How is Herpes Zoster diagnosed?
The doctor typically confirms the diagnosis if a previous history of chickenpox can be elicited.
The condition is diagnosed by a characteristic rash of blisters distributed over the area of supply of a single nerve. The fluid in the blisters can be taken for microscopic examination.
What is the treatment for Herpes Zoster?
- Painkillers are the mainstay of treatment
- Anti-viral drugs like acyclovir along with/without steroids
- Topical ointments for soothing the burning sensation
What are the complications with Herpes Zoster?
- Dissemination (spread of rash)
- Involvement of the eye
- Involvement of the ear causing hearing loss and vertigo
- Recurrent pain in the area of involvement called postherpetic neuralgia (PHN)
How can Herpes Zoster be prevented?
Varicella vaccine has been shown to be useful and has been in use since 2006. It provides protection of up to 90% for a period of 3.5 years. However, this should not be used in persons with severely compromised immunity. This vaccine is recommended for adults over 65 years of age, especially diabetics. Even in case of occurrence, the vaccine helps in preventing the complications of the disease and PHN.
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