Shingles aka Herpes zoster
Herpes zoster, or shingles, is a common skin disease characterized by a painful, one-sided band like blistering eruption. It may occur at any age, but is more common in the elderly.
The disease represents reactivation of the chicken pox virus which remains dormant in the body after that infection. It is estimated that by age 85 at least half of the population will have had one attack of Herpes zoster. Second attacks, although uncommon, may occur in around 1% of individuals.
Patients with shingles are infectious to people who have not had chicken pox; thus an immunologically naive person may contract chicken pox from a person with shingles. Patients with advanced cancer may also be at risk and should be isolated from patients with Herpes zoster.
The first symptom of shingles is pain or an abnormal sensation in the area which will later develop the rash. This may last for a few days before the rash occurs, and may be mistaken for a number of medical or surgical problems: such as, pleurisy, heart attack, ulcer disease, appendicitis, disc problems, and others.
The rash, when it occurs, is distinctive. It is band-like and does not cross the mid-line of the body, being entirely on the right or left side. It is made up of blisters which vary in size from patient to patient, some being quite small and clear, others being large and occasionally blood-filled. The rash spreads for 1-4 days, dries, and crusts for 7-10 days, and heals over 2-3 weeks. It tends to be more severe in older patients.
Treatment:
The uncomplicated case requires no special treatment. Pain medications (aspirin, acetaminophen, or codeine) are sometimes necessary. Cool compresses and calamine lotion may speed up drying of the blister, and the application of olive oil to the crusts will help to loosen them. In the 1980s, it was demonstrated that acyclovir (and more recently Famvir and Valtrex) can shorten the duration of zoster. This is only true if the drug is started within three days (72 hours) of the onset of the rash. It is important to keep in mind that acyclovir are not very effective in preventing post-herpetic neuralgia and that for thousands of years people have recovered from herpes zoster without any therapy.
Complications:
1. Pain may last for months to years after an attack. This is rare in patients less than age 50, but more common in patients over 60. The name for this syndrome is "Post-Herpetic Neuralgia."
2. Dissemination: 2 to 10% of patients with H. zoster may have many blisters outside of the original band covering wide-spread areas of the body. This is usually not serious.
3. Secondary infection may occasionally occur in zoster lesions. This is by no means the rule, but one must look for it.
4. When shingles occur on the forehead and especially the tip of the nose, the possibility of eye involvement exists. Your doctor will know when to refer you to an eye specialist, as involvement of the eye with H. zoster requires prompt treatment.
5. There are a number of other rare complications which may occur. Most of these are related to the muscles and nerves. Consult your doctor if anything unusual occurs with or shortly after your zoster.
6. Zoster may be more severe in HIV positive patients. Special attention should be given to zoster patients at risk for HIV infection.