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Herpes zoster


Herpes zoster, a viral disease that goes by its more common name, shingles, is preceded by the varicella zoster virus, which causes chickenpox in children and young adults. Despite being a relatively short-lived illness, the chicken pox virus remains in a person's body, appearing as shingles several years after the person has contracted chickenpox.

HERPES ZOSTER SYMPTOMS

Herpes zoster exhibits several symptoms far removed from the appearance of chicken pox. In most cases, these symptoms are seen on only one side of the body. Herpes zoster appears in an average of 2.3 people out of every 1,000 individuals around the world each year. This number increases among people older than 65.

The Herpes zoster virus can attack people of all ages, but it is more common in people over 60, in children who have contracted chickenpox before they reached their first year, and in patients with weak immune systems.

The duration of Herpes zoster symptoms can be reduced with the treatment of antiviral medications, particularly if administered within 72 hours after symptoms appear.

Herpes zoster's first symptoms appear in the form of headaches, a fever, and general malaise. These symptoms are relatively non-specific, and they are usually misdiagnosed as other ailments. From these initial symptoms, the patient will then experience itching, pricking, oversensitivity (hyperesthesia), numbness, burning pain sensations, tingling, as well as a sensation of “pins and needles”. In some cases, the skin affected by shingles may become extremely painful, with throbbing and numbing sensations in between. These sensations are interrupted by brief episodes of severe pain.

After a period of 2 days to 3 weeks, the second phase of symptoms manifests themselves in a skin rash. Both the pain and the rash are usually experienced around the region of the torso. However, they can also appear in other areas of the body, like the eyes, mouth, ears, and face. The rash is similar in appearance to hives, and akin to the initial appearance of chicken pox blisters, but they grows in a striped pattern or belt-like design on only a single side of the torso, usually along the spine, stomach, or chest.

The pus-filled blister-like rashes eventually break and turn into miniature ulcers. These ulcers then dry up, become encrusted, and the resulting scabs fall off within the space of 3 weeks. With some cases of severe blistering, patients may experience some scarring, with discolored patches of skin remaining for an extended period of time.

The rash usually involves a narrow area of the spine, as well as the belly area, and chest. It may also appear on the face, eyes, mouth and ears.

Apart from the initial symptoms of fever and headaches, the patient may experience chills, joint pain, swollen lymph nodes, abdominal pain, problems with hearing, taste and vision, vertigo, drooping eyelids, a difficulty moving facial muscles, and genital lesions.

In rare cases, the virus can also cause a palsy of the optic nerve, and various inflammatory conditions like conjuctivitis, uveitis, and keratitis, which are accompanied by severe pain.
herpes zoster
Image: Herpes Zoster


Any person who has had chickenpox in childhood or young adulthood may contract the Herpes zoster virus several years later. This is because the chicken pox virus continues to lie dormant in the patient's nervous system even after the symptoms disappear. Why and when the Herpes zoster virus reactivates is still not known, and in a majority of shingles cases, only a single reactivation of the virus occurs.

If a person who has not had the chickenpox in childhood or young adulthood is exposed to a carrier of the Herpes zoster virus, this person is liable to contract severe chickenpox instead of shingles. This is because there had been no immunity from the chickenpox virus previously.

HERPES ZOSTER DIAGNOSIS

The doctor will make a diagnosis by taking down the patient's complete medical history, as well as closely examining the patient's skin. Shingles are relatively easy to diagnose once the telltale blister-like rashes make their appearance. This is particularly true once they start forming into a belt-like pattern on one side of the body, also known as the dermatomal pattern. When the rashes are present, laboratory tests are seldom called for. However, the doctor may take a skin sample to make sure that the Herpes zoster virus has indeed caused the infection.

HERPES ZOSTER TREATMENT

The doctor may order a Tsanck smear to determine the existence of the virus for a more accurate diagnosis. Other laboratory tests include the VZV-specific IgM antibody that is acquired through a blood test, usually as soon as the virus has reactivated from its dormant state. A polymerase chain reaction can also be tested for VZV DNA from lymph samples taken from shingles blisters. Traces of the Herpes zoster virus can also be detected through an electron microscope.

After it makes its full run, the Herpes zoster virus disappears by itself. The objective in the treatment of shingles, therefore, is to decrease the severity, as well as the duration of the infection's symptoms, particularly the ones involving severe pain, throbbing, and burning. Treatment for the Herpes zoster virus also aims to shorten the period of the illness, and to lessen the chances of complications. In some cases, if complications have already arisen, such as the development of postherpetic neuralgia, appropriate symptomatic treatment for these complications may be necessary.


The doctor may prescribe acyclovir, an antiviral drug meant to decrease the incidence of pain, reduce any instances of complications, as well as to shorten the duration of the infection. Other medications that have a similar therapeutic effect include Desciclovir, valacyclovir, famciclovir, and penciclovir. These medications, when administered within a day of the first symptoms of pain and burning, and before the first blisters make their appearance, have been proven to be effective. While they are available in pill form, in some cases, intravenous administration of these drugs may be given.

HERPES ZOSTER PREVENTION

To reduce pain and swelling, the doctor may prescribe potent anti-inflammatory drugs known as corticosteriods. Oral or topical antihistamines may also be necessary to reduce itching. To prevent complications, such as post-herpetic neuralgia, Zostrix, a topical cream with capsaicin content may be given.

The patient may also apply cool and wet compresses to the affected area to reduce pain symptoms, while warm oatmeal or starch baths, followed by an application of soothing calamine lotion, can relieve itching and discomfort.

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