Shingles on the forearm
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Herpes zoster

Herpes zoster, colloquially known as shingles, is the reactivation of varicella zoster virus, leading to a crop of painful blisters over the area of a dermatome. It occurs very rarely in children and adults, but its incidence is high in the elderly (over 60), as well as in any age group of immunocompromised patients. It affects some 500,000 people per year in the United States. Treatment is generally with antiviral drugs such as acyclovir. Many patients develop a painful condition called postherpetic neuralgia which is often difficult to manage. more...

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In some patients, herpes zoster can reactivate subclinically with pain in a dermatomal distribution without rash. This condition is known as zoster sine herpete and may be more complicated, affecting multiple levels of the nervous system and causing multiple cranial neuropathies, polyneuritis, myelitis, or aseptic meningitis.

The word herpes came from Greek, which is cognate with serpent and, as can be expected, herpetology. Interestingly, the skin disease is also commonly known as "snake" in Chinese.

Signs and symptoms

Often, pain is the first symptom. This pain can be characterized as stinging, tingling, numbing, or throbbing, and can be pronounced with quick stabs of intensity. Then 2-3 crops of red lesions develop, which gradually turn into small blisters filled with serous fluid. A general feeling of unwellness often occurs.

As long as the blisters have not dried out, HZ patients may transmit the virus to others. This could lead to chickenpox in people (mainly young children) who are not yet immune to this virus.

Shingles blisters are unusual in that they only appear on one side of the body. That is because the chickenpox virus can remain dormant for decades, and does so inside the spinal column or a nerve fiber. If it reactivates as shingles, it affects only a single nerve fiber, or ganglion, which can radiate to only one side of the body. The blisters therefore only affect one area of the body and do not cross the midline. They are most common on the torso, but can also appear on the face (where they are potentially hazardous to vision) or other parts of the body.

Diagnosis

The diagnosis is visual — very few other diseases mimic herpes zoster. In case of doubt, fluid from a blister may be analysed in a medical laboratory.

Pathophysiology

The causative agent for herpes zoster is varicella zoster virus (VZV). Most people are infected with this virus as a child, as it causes chickenpox. The body eliminates the virus from the system, but it remains dormant in the ganglia adjacent to the spinal cord or the ganglion semilunare (ganglion Gasseri) in the cranial base.

Generally, the immune system suppresses reactivation of the virus. In the elderly, whose immune response generally tends to deteriorate, as well as in those patients whose immune system is being suppressed, this process fails. (Some researchers speculate that sunburn and other, unrelated stresses that can affect the immune system may also lead to viral reactivation.) The virus starts replicating in the nerve cells, and newly formed viruses are carried down the axons to the area of skin served by that ganglion (a dermatome). Here, the virus causes local inflammation in the skin, with the formation of blisters.

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What you should know about HZO - Information from Your Family Doctor - Herpes zoster ophthalmicus - shingles
From American Family Physician, 11/1/02

What is HZO?

Herpes zoster ophthalmicus (HZO), commonly known as shingles is caused by the chickenpox virus. It involves the skin around the eye and sometimes the eye itself. It is not the same virus that causes herpes simplex.

What are the symptoms of HZO?

HZO can cause a rash with small blisters to break out on the forehead and around the eye on one side of your face. Sometimes you will have pain in the same area of your face a few days before the outbreak.

Who gets HZO and why? Can I prevent it?

There is nothing you can do to prevent HZO. It is not common in children, but it occurs more often as people get older. Men and women are equally affected. Often people who get HZO have had chickenpox or have been exposed to the chickenpox virus in the past.

How can my doctor tell if I have HZO?

If you have HZO, you will probably have a rash that looks like chickenpox, but only on one side of your face. Besides examining you, your doctor will not need to do any additional tests to see if you have HZO. Sometimes herpes simplex infections can resemble HZO. However, the patterns of the rashes are different and your doctor will be able to tell them apart.

How often is the eye involved?

The eye itself is affected in 10 percent of patients. Your doctor will examine you to see if the eye is involved. If it is, you may need to see an ophthalmologist (a doctor who specializes in treating eyes) for further treatment.

How is HZO treated?

If you think you might have HZO, see your doctor right away. Early treatment with antiviral medicines can reduce pain and the duration of symptoms. Your doctor can give you advice about treatment, but rest is also important. Cool compresses can ease the pain and rash. Pain medicine such as aspirin or acetaminophen (Tylenol) may help.

How long will I have the infection?

If you have pain from HZO, it should get better as the rash goes away. With uncomplicated HZO, you should recover in a few weeks, but it may take longer in older or sicker patients.

Can I infect other people?

If you have HZO, you can give the virus that causes chickenpox to other people. Therefore, you should avoid people who have not had chickenpox (especially pregnant women) and very sick patients (such as patients with cancer or AIDS). If you live with children who have not had chickenpox, you should tell your doctor. They may need to be vaccinated.

COPYRIGHT 2002 American Academy of Family Physicians
COPYRIGHT 2002 Gale Group

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