(Common Name: Shingles, In Latin, Shingles means a band)
Herpes Zoster is an acute viral condition involving skin and nerves that manifests as painful bunches of blisters over a reddish base arranged in a band like fashion along the distribution of one or more nerves over one side of the body
Herpes Zoster (HZ) shows wide variation in its features. The range of variation may vary from being so mild as to be barely noticeable to so severe that might result in disfigurement, paralysis, and brain infection. The classical picture shows bunches of blisters over reddish skin areas that are arranged like a band or stripe. The pain accompanying blisters and persisting after healing, known as Post Herpetic Neuralgia (PHN) can be extremely severe and unbearable.. A lack of awareness about the disease is known to result in errors in diagnosis and management. An accurate knowledge about how to deal with Herpes Zoster can save a lot of physical and financial burden.
· HZ is found in every part of the world, affects both genders, and occurs primarily in the aged individuals. It can affect individuals of younger age groups as well.
· More than one million cases of HZ are reported every year in India.
· Herpes Zoster is caused by Varicella Zoster Virus (VZV). VZV virus is different from
the virus causing cold sores and genital herpes.
- When we get chickenpox, the VZV virus
enters our body and stays hidden there without any symptoms. When this virus
gets reactivated, it manifest as HZ. This is thought to be a result of a drop
in level of immunity. HZ is nit the same disease as chickenpox.
- HZ is infectious and an individual coming
in contact with infected case for the first time in life develops features of chickenpox.
- There are several variants of HZ which are
named according to the nerves involved.
- The commonest form of HZ manifestation is
seen on trunk with lesions staying confined to either half of the body.
- The HZ blisters tend to heal by themselves
in about a week. Therefore, it is treatable condition despite converse belief prevalent in some communities
- The accompanying symptoms and after
effects of HZ, especially the pain called post herpetic neuralgia or PHN, can
be minimized by medicines including analgesics and antiviral medications. The
latter prove beneficial when given in early stage, preferably within first
three days of onset of infection.
- Vaccination is recommended for subjects
at risk. An individual can get a repeat infection.
Features, Self help, & Preventive Measures
HZ starts with a pre-eruptive phase. Pre-eruptive phase distinguished by pain or abnormal sensation with or without any redness does not show any typical features like blisters on the skin and hence is most prone to be missed or misunderstood as muscular pain, sprain, or another cause. However, localization of pain to one half of the body must arouse the suspicion of HZ. It must be considered especially if the subject is elderly and has had any of the following events causing drop in immunity levels. Some of the risk factors are
2. Trauma like surgery or fractures
3. Concomitant diseases like immune-deficient states
Diagnosis of HZ is generally based on classical lesions and their stripe like distribution. The individual lesions are dome shaped showing umblication or a crater in the centre. Sometimes laboratory investigations might be needed to establish diagnosis.
Blistering phase takes a week or so to clear up and is best managed by rest, good diet, local hygiene, analgesics, antibiotics, and antiviral treatment commenced preferably within first three days of onset. One should stay as active as possible. HZ can lead to complications like infection of the brain, nerve damage, impaired hearing and loss of vision. Contact between patient and children or individuals with weak immune system should be avoided.
There is no cure for HZ. However, it is possible to minimize the severity of illness. Antivirals help in several ways including the reduction of virus counts and risk of PHN. Antivirals show best results when administered in early phase of infection. Role of steroids in HZ is controversial. In several patients PHN becomes the main concern as it can be severe, prolonged and disturbing. The drugs used for PHN are analgesics, anticonvulsants, and antidepressants. Some patients might need heavy doses of analgesics, combination of different drugs or surgical intervention to control PHN.
A recombinant vaccine is known to be effective in preventing HZ in the elderly. This vaccine has been approved by FDA.
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Dr Vinay Kumar
Senior Consultant Dermatologist
+91-93 199 299 00
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