Herpes zoster or shingles
affects 20% of the adult population and occurs most commonly
in individuals over the age of 50 years. The terms herpes zoster
are of Greek origin, herpes meaning "to creep"
and zoster meaning "girdle" or "belt".
Herpes zoster is caused by the reactivation of the varicella-zoster
virus (VZV) that has taken up residence in a nerve cell following
chickenpox (varicella). Reactivation
is believed to be caused by lowered body immunity (resistance)
- Old age.
- Underlying cancer.
- Drugs which may suppress
immunity, for example anti-cancer drugs and systemic steroids
(i.e., steroids taken by mouth or injected).
- X-ray therapy.
- AIDS (acquired immune
- The earliest symptom
is burning, itching, tingling or pain which may precede the rash
by 4 - 5 days.
- A line or cluster
of blisters develop on one side of the body corresponding to
the distribution of the nerve in which the old varicella-zoster
virus has taken up residence.
- Blisters ulcerate,
crust over and form dry scabs. These heal after 2 - 3 weeks,
- Pain, which may be
severe and prolonged, lasting for several months.
- Fever, malaise (feeling
of illness) and headache.
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- Herpes zoster affecting
the 5th cranial nerve may involve the cornea (transparent covering
of the eye), causing scarring and visual impairment. The risk
of this occurring is increased when blisters appear on the sides
or tip of the nose.
- Dissemination - herpes
zoster may spread ouside the distribution of the nerve and cause
disseminated herpes zoster in individuals with underlying cancers
(such as leukaemia and lymphoma) and those on immunosuppressive
- Ramsay Hunt syndrome
due to involvement of the 7th and 8th facial nerve causing facial
paralysis, tinitus (ringing in the ear), vertigo (giddiness with
the room spinning around) and blisters on the tongue, the ear
and its canal.
- Postherpetic neuralgia
- This is defined as pain that has persisted at least 4 weeks
after the appearance of the rash. Twenty per cent of those over
60 years of age may be affected. Postherpetic neuralgia causes
itching, tingling, burning and sharp shooting pains. The pain
may precipitated by light touch over the affected area and can
be extremely debilitating. It is difficult to treat.
What you can do
- You should consult
a doctor early as treatment is most effective when treatment
is started within 72 hours of the appearance of the rash.
- Take painkillers.
- Take antihistamines
if there is itching.
- Apply saline compresses
to dry up the blisters and keep the area clean.
- Avoid contact with
children who have not had chickenpox before because there is
a small risk of transmitting the virus to children, causing chicken
pox. Adults usually are not at risk since most of them had already
had chickenpox and herpes zoster would be a reactivation of this
old virus within themselves rather than from another person.
What the doctor
- Confirm the diagnosis.
- Refer to an ophthalmologist
if there is eye involvement.
- Prescribe strong painkillers
- Prescribe acyclovir,
valcyclovir or famcyclovir to reduce symptoms and hasten recovery.
Treatment also reduces the risk of postherpetic neuralgia.
- Treat postherpetic
neuralgia - antidepressants, tranquillisers, intralesional
steroid injections into the painful areas, strong painkillers,
carbamezapine, pimozide, capsaicin cream, TENS (transcutaneous
electrical nerve stimulation) and sympathetic nerve block may
be tried in this very difficult problem.