Herpes zoster Health Article

Symptoms

• Warning symptoms of unilateral (on one side) pain, tingling, or burning sensation limited to a specific part of the body -- pain and burning sensation may be intense
• Reddening of the skin (erythema) followed by the appearance of blisters (vesicles)
• Grouped, dense, deep, small blisters that ooze and crust

• Fever, chills
• General feeling of malaise
• Headache
• Lymph node swelling
• Vision abnormalities
• Taste abnormalities
• Drooping eyelid (ptosis)
• Loss of eye motion (ophthalmoplegia)
• Hearing loss
• Joint pain
• Genital lesions (female or male)
• Abdominal pain

Signs and tests

Diagnosis is suspected based on the appearance of the skin lesions, and strengthened by a prior history of chickenpox or shingles. It can be confused with herpes simplex.

Tests are rarely necessary, but may include:

• Viral culture of skin lesion
• Tzanck test of skin lesion
• Complete blood count (CBC) may show elevated white blood cells, a nonspecific sign of infection
• Specific antibody (immunoglobulin) measurement demonstrates elevation of varicella antibodies

Treatment

Herpes zoster usually disappears on its own, and may not require treatment except for symptom relief, such as pain medication.

Acyclovir is an antiviral medication that may be prescribed to shorten the course, reduce pain, reduce complications, or protect an immunocompromised individual. Desciclovir, famciclovir, valacyclovir, and penciclovir are similar to acyclovir and may be used to treat herpes zoster.

For the greatest effect, treatment with acyclovir-like medications should start within 24 hours of the appearance of pain or burning sensation, and preferably before the appearance of the characteristic blisters.

Typically, the drugs are given as pills, in doses four times greater than those recommended for herpes simplex or genital herpes. Severely immunocompromised individuals may require intravenous (IV) acyclovir therapy.

Corticosteroids, such as prednisone, may occasionally be used to reduce inflammation and risk of post-herpetic neuralgia. They have been shown to be most effective in the elderly population. Corticosteroids have certain risks that should be considered before using them.

Pain medicines (analgesics, mild to strong, may be needed to control pain. Antihistamines may be used topically (direct application to the body) or orally (by mouth) to reduce itching. Zostrix, a cream containing capsaicin (an extract of pepper), may prevent post-herpetic neuralgia.

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or lotions and calamine lotion, may help to relieve itching and discomfort. Resting in bed until the fever goes down is recommended.

The skin should be kept clean, and contaminated items should not be re-used. Non-disposable items should be washed in boiling water or otherwise disinfected before re-use. The person may need to be isolated while lesions are oozing to prevent infection of others -- especially pregnant women.