Herpes Zoster (Shingles)

Introduction

-Herpes zoster results from reactivation of latent varicella-zoster virus infection within the sensory ganglia 

-It is usually characterized by a painful, unilateral vesicular eruption in a dermatomal distribution 

-It is usually occurs among adults, but rarely occurs in other age groups also. 

Symptoms & Signs 

-Most commonly involved sites of herpes zoster: trigeminal, thoracic and lumbar 

-It is usually confined to a single dermatome on one side and associated with burning pain in the affected area, fever, malaise, headache

-The rash starts as grouped vesicles and later become pustular and crusty. 

Herpes zoster ophthalmicus: Lesions on tip of nose, inner corner of eye and root and side of nose (Hutchinson sign) 

Herpes zoster oticus (Ramsay Hunt syndrome): vesicles in the ear canal, hearing loss, vertigo, tinnitus, Bell palsy; due to reactivation of VZV within the geniculate ganglion. 

-The lesions are considered infectious until they dry and crust over 

Diagnosis 

-Diagnosis is based on the clinical presentation

Treatment 

Antiviral agents: Acyclovir, valacyclovir, famciclovir, beneficial if started within 72 hours after the eruption of the rash 

Anterior uveitis: topical steroids, cycloplegics 

Corticosteroids do not prevent the development of postherpetic neuralgia

Prevention 

-Two shingles vaccines (Zostavax and Shingrix) are available for adults who have had chickenpox. 

-Shingrix is preferred over Zostavax.

-Shingrix is approved and recommended for people age 50 and older, including those who’ve previously received Zostavax. 

-Zostavax isn’t recommended until age 60. 

-Shingles can spread through direct contact with herpes zoster lesions 

-Patients should avoid contact with pregnant women who have never had chickenpox or varicella vaccine, immune deficiencies, and premature infants. 

Q.What is the most common complication of zoster in elderly adults? Postherpetic neuralgia 

Q. What is the most common cause of acute retinal necrosis? Herpes zoster virus

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