| What is Herpes zoster? | • Herpes zoster or shingles: localized rash due to varicella zoster virus (VZV)
• Resurgence of virus remaining latent after primary infection or chickenpox
• Unilateral dermatomal distribution is characteristic of the disease |
| How is the typical presentation of herpes zoster? | i) Pre-eruptive stage:
Unilateral pain superficial half-belt, burning or itching
sometimes with a fever of 38 ° C, dysesthesia and satellite
lymphadenopathy
ii) Eruptive phase:
• rash erythematous vesicular unilateral vesicles lining
macules, are grouped in bunches, first translucent and then
troubles erosions and crusts
• Successive outbreaks occur leaving depigmented scars
• The duration varies from 15 to 20 days up to 3-4 weeks
• Unilateral radicular topography (intercostal) guide the
diagnosis |
| What are other locations of herpes zoster? | • Zona ophthalmic: this is the most common cranial nerve herpes zoster. The eruption registered in one or more of the three branches of the trigeminal nerve, especially in its ophthalmic branch (V1). Ocular complications may occur (keratitis, iridocyclitis, optic nerve, paralysis of the oculomotor nerve)
• Zona geniculate (Ramsey-Hunt syndrome): to seek before any peripheral facial paralysis. The eruption set in the area of Ramsey- Hunt, causing pain in the ear and mouth
• Zona of the limbs: band sometimes making rash limb length in an area corresponding to one or more roots
• Zona of the oral mucosa: stomatitis, pharyngitis or laryngitis with unilateral erosions |
| How is biological workup of herpes zoster? | Rarely useful in the diagnosis:
- Serology: elevated IgM from the 3rd day
- Viral culture (from vesicles or erosions)
- PCR |
| How is evolution and prognosis of herpes zoster? | - In the typical form, the evolution is good in 3-4 weeks. Residual pain may persist for several weeks
- In the immune compromised patients (AIDS), the rash is often necrotic with superficial ulceration, which can spread throughout the body. The pains are intense. Internal involvement as meningitis or hepatitis may occur |
| How is tx of Herpes zoster? | • i) For typical presentation: rest. Disinfection of the
lesions. Use analgesics or sedatives. Aciclovir or
valaciclovir orally may shorten the duration of the
eruption. Postherpetic neuralgia is difficult to treat and sometimes we use antidepressants
• ii) Severe forms: immune compromised, ophthalmic
zoster, elderly. Hospitalization and start IV of aciclovir
at effective dose (15-20 mg / kg 3 times daily) leading
to a healing of the lesions. Monitoring of renal function
is necessary in the treatment with aciclovir if repeated
infusions |
