Herpes Zoster is a contagious skin disease which is also known as shingles in common language. It is localized viral infection which is characterized by presence of painful blisters in a particular area on one side of the body.
Herpes Zoster is caused by the same virus, Varicella Zoster Virus, which causes chickenpox. Chickenpox which is the short-lived illness is caused as initial reaction to the viral infection. Symptoms of chicken pox are cleared off within few days but virus remains dormant in the nerve cells which can become active even after many years of initial reaction.
Herpes Zoster is seen mainly in children and people over 60 years of age. Factors which cause re-activation are most probably the stress, aging or impaired immune system.
In its dormant state, VSV lies in nerve tract, emerging from spine. When it becomes, reactive, it spreads in whole tract and gives burning sensation and pain. When it reaches the tip of the nerve on the skin, rash appears after 2-3 days.
A person who never had chicken pox earlier can get infected by Herpes Zoster by direct contact and people who has low immunity level can also get this infection. People who are suffering from leukemia, other cancers, atopic dermatitis, Hodgkin’s disease, HIV infection or AIDS are at risk of this infection. People who are taking drugs for suppressing immune system are also at risk.
It takes 2-3 days for rashes, due to herpes zoster, to appear after virus reaches the skin.
Initial symptoms are fever, headache, fatigue and flulike symptoms which often lead to wrong diagnosis. Then other specific symptoms like burning pain, itching, sensitivity to heat, light, cold or touch start appearing. There is stinging, tingling, numbing, throbbing or aching sensation in the affected dermatome.
After 1 or 2 days and in many cases up to three week, characteristic skin rash of herpes Zoster appears on the skin. Most common place for appearance of rash is torso but face and eyes are also at risk. It occurs on torso only because it affects areas supplied by spinal nerve. Normally stripe or belt-like pattern is seen which is limited to one part of the body but these rashes do not cross the midline.
Then these rashes get converted into vesicular which forms tiny blisters which are filled with serous exudates. Gradually, these blisters get filled with blood and become dark and red. Within 7 to 10 days, crust over these blisters appears. Eventually, this crust falls off and skin starts healing. In severe cases, blisters leave scars and discolored skin.
VSV reactivating in trigeminal nerve in the face can affect neck or face. There are three branches in this nerve; forehead, mid-face and the lower face. Skin lesion will be on the part depending upon the nerve involved.
Herpes Zoster is diagnosed by visual examination and other accompanied symptoms. It is recognized by pattern of rashes. If there is no characteristic rash in early or late stage as in Herpes Zoster Sine, it becomes difficult to diagnose. There are laboratory tests available to find out and confirm the Herpes Zoster.
Herpes Zoster is a viral infection: it resolves itself after few days without any treatment but patient needs a relief from its symptoms like pain and itch.
Patients are given antiviral medication to reduce pain, itching, shortening the course and reduce complications. Medicines like Acyclovir, valacyclovir, famciclovir Desciclovir and penciclovir are advised.
These medications should be started within 24 hours of appearance of initial symptoms like pain and burning sensation and before the appearance of blisters, for the best results.
Doses of medicines given are for times stronger than that given in case of herpes simplex. Sometimes intravenous therapy has to be used.
To reduce inflammation and other risk of post-herpetic neuralgia, Corticosteroids are given in rare cases.
Other drugs like analgesics to reduce pain, antihistamines to reduce itching are advised along with antiviral drugs.
Other precautions and measures can be taken to make the patient comfortable.
To reduce pain, cool compress can be applied
To relieve itching and discomfort, soothing baths and lotions can be taken.
Bed rest until fever goes down.
Do not use contaminated items.
The items which can not be disposed off like cloths and bed sheets etc. should be disinfected with boiling water.
Isolation of patient is must to prevent spread of infection to others by contact.
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