Herpes Zoster Treatment, (SHINGLES)

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Herpes Zoster Treatment, (SHINGLES)

Herpes Zoster Treatment (SHINGLES), Postherpetic Neuralgia Cause, Symptoms, Complications,
Investigations

Herpes Zoster Cause:

Herpes Zoster is painful, self-limited, dermatomal rash caused by reactivation of Varicella-Zoster virus.

Varicella-zoster virus causes- Shingles (Herpes Zoster) & chicken pox (varicella).

Mostly patient adult, old age, as immunity decreases against varicella-zoster virus.

Three phases:-

Pre-eruptive phase (preherpetic neuralgia)- pain along affected dermatome. After 2-3 days-

Acute eruptive phase.

Chronic phase (post-herpetic neuralgia)

Severe pain without vesicular eruption (Zoster sine herpete)

Usually symptoms resolved in 10-15 days, healing of lesion may take a month.

Herpes Zoster Symptoms:

Severe pain precedes appearance of rash. malaise, myalgia, headache, fever uncommon

Lesions in dermatomal distribution, thoracic & lumbar roots are commonly involved.

Regional lymph nodes may be enlarged.

Herpes zoster ophthalmicus- inner corner of the eye, tip of the nose, root & side of the nose- show trigeminal nerve involvement (Hutchinson sign).

Herpes zoster oticus or Ramsay Hunt syndrome- Facial palsy & lesions of external ear with or without involvement of tympanic membrane, tinnitus, vertigo, or deafness indicates involvement of the geniculate ganglion.

Herpes Zoster Investigations:

Diagnosis made on clinical ground.

Detection of VZV DNA in tissue or CSF.

PCR from scrapings of lesions or direct immunofluorescent antibody staining, both are more sensitive than a culture.

Tzanck smear of vesicular lesion

Leukopenia and mild transaminase elevation present.

Herpes Zoster Complications:

Postherpetic neuralgia, (Elsberg syndrome) sacral meningoradiculitis,

bacterial superinfections of skin,

geniculate ganglion involvement of cranial nerve VII & other cranial nerve V, VIII, IX, & X,

herpes zoster ophthalmicus, aseptic meningitis, transverse myelitis,

peripheral motor neuropathy, encephalitis, stroke, acute cerebellitis,

acute retinal necrosis, temporal arteritis, progressive outer retinal necrosis, .

In HSV seronegative VZV is major cause of Bell’s palsy.

Herpes Zoster Treatment:

In herpes zoster uncomplicated-

Tablet valacyclovir 1gm three times a day or

Tablet famciclovir 500 mg three times a day or

Tablet acyclovir 800mg (20 mg/kg) three times a day for 7 days.

Amenamevir.

Corticosteroid 60mg OD then tapering course for 2-3 weeks for fast acute lesions resolution.

In complications extradermatomal- Intravenous Acyclovir 500mg three times a day.

Postherpetic Neuralgia Treatment:

Gabapentin tablet 100-300 mg three times a day or

tablet pregabalin 75 mg twicw a day or

lidocaine patches.

Tricyclic antidepressants- amitriptyline tablet 10-75 mg in night (causes giddiness in higher doses) ,

capsaicin cream,

opioids,

anticonvulsant

NSAID’s, etc

Gabapentin with nortriptyline 2-4 times a day &

clonazepam 1-3 times a day is good in Postherpetic Neuralgia pain control.

Advice From- DR RAKESH UKEY MBBS, MD MEDICINE.:-

Please consult in clinic, then start medicine according to diagnosis.

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