Herpes Zoster (shingles)

Clinical Description

After an episode of chicken pox, the varicella zoster virus will remain in the body within nerves but kept inactive by one’s immune system. A reactivation of this varicella zoster virus may occur at any time later on, leading to inflammation of the dermatome supplied by the nerve.

Causes: varicella zoster virus

• Populations at risk are those immunosuppressed due to HIV infection, old age, other immunosuppressive medication, diabetes and many others.
• Any dermatome may be affected by commonly affected ones include thoracic, trigeminal, cervical and sacral dermatomes.

Signs and Symptoms

• Tingling burning sensation or painful skin along a dermatome.
• Painful vesicles, on an erythematous base, which later develop blisters or erosions.

Treatment

• Give Acyclovir 800mg 5 times a day for 5-7 days; best clinical outcome is if initiated within 24 -72 hours from onset of the lesions.
• Apply calamine lotion on intact lesions for their fast drying.
• Give analgesics and carbamazepine for pain relief
• For ophthalmic herpes zoster treat as above and refer to eye department urgently.
• If status not known, refer for HIV testing for any patient regardless of age and underlying medical risk factors.

NOTE: In the HIV immunosuppressed patients, continue treatment with acyclovir until all lesions have healed.