HERPES ZOSTER

Herpes zoster or shingles is the recrudescence of a latent varicella-zoster
infection in the partially immune host. After a short period of itch, tenderness
or pain along one or occasionally several dermatomes on one
side of the body papules and plaques appear which quickly change into
blisters. Most often thoracic and cervical dermatomes are affected. If the
ophthalmic branch of the trigeminal nerve is involved a keratoconjunctivitis
may develop and can lead to blindness. After 1-2 weeks crusts begin
to fall off. Over 10% of patients develop post-herpetic neuralgia, a persistent
burning sensation or pain in the area which has healed. This can
last from a few months to many years.
Herpes zoster may appear in otherwise healthy persons, especially the
elderly, but is much more common in people with underlying malignancies
and HIV-infection. It is an early indicator of HIV-infection in young
people. Delayed healing, dissemination and complications are more common
and severe in immunocompromised persons.
Management of herpes zoster
- Analgesia with NSAID’s, e.g. indomethacin 25 mg 3 times daily or ibuprofen 400 mg
3 times daily.
- Antibiotics for superinfection, as this is the main cause of keloidal scarring.
- Use betadine scrub/shampoo as a soap, do not use vaseline.
- Calamine or phenol-zinc lotion for vesicular stages.
- If the eye is involved refer to an eye-clinic
- In immune compromised persons if available acyclovir 800 mg 5 times daily for
1 week. Start acyclovir or other available antiviral (e.g. valaciclorir) early in the
course of the disease.
Postherpetic neuralgia:
- 3 to 5% phenol in cream or
ointment 2-6 times daily.
- Amitryptiline 75 mg nightly or
- Carbamazepine 600-800 mg once
daily or
- Amitryptiline 75 mg nightly +
thioridazine 25 mg 4 times daily.
Try any of these for at least 4-6
weeks before deciding whether
they are effective.
48
Fig. 55. Herpes Zoster in
more than one
dermatome in a 30 year old
HIV positive man.