HERPES ZOSTER (Shingles)

General Information

DEFINITION--A painful viral infection of the central nervous system.

BODY PARTS INVOLVED--Sensory nerves of the skin on one side of the body.

SEX OR AGE MOST AFFECTED--All ages, but most common in adults over 50.

SIGNS & SYMPTOMS

• Painful red blisters anywhere on the body. Blisters appear 4 to 5 days after early symptoms begin. The blisters appear on a broad streak of reddened skin along sensory-nerve routes to a particular area of skin. They occur most often on the chest, and spread only on one side of the body.
• Mild chills and fever.
• General ill feeling.
• Mild nausea, abdominal cramps or diarrhea.
• Chest pain, face pain, or burning pain in the skin of the abdomen, depending on the affected area.

CAUSES--Herpes zoster is caused by the varicella-zoster virus, the same virus that causes chickenpox. It may lie dormant in the spinal cord until triggered by risk factors.

PREVENTIVE MEASURES--Cannot be prevented at present. Varicella vaccines under investigation have not eliminated zoster. With rare exceptions, one attack of zoster confers lifelong immunity.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Diagnosis is usually not possible until rash appears. Before then, the symptoms may mimic appendicitis, pleurisy or other conditions. Diagnostic tests may include laboratory blood tests and culture of fluid from blister, and skin biopsy (rare). APPROPRIATE MEDICAL CARE
• Self-care after diagnosis.
• Doctor's treatment.

POSSIBLE COMPLICATIONS

• Secondary infection in the blisters.
• Chronic pain, especially in the elderly, that persists for months or years in the sensory nerves where the blisters have been.
• Corneal ulceration.
• Central nervous system infection.
• Direct contact with herpes zoster can give a susceptible person chickenpox.

PROBABLE OUTCOME--The rash usually clears in 14 to 21 days. The nerve pain may last for another month or longer. One attack usually provides immunity against herpes zoster, but a few persons have had more than one attack.

How To Treat

GENERAL MEASURES--

• Primary goal of treatment is to relieve the itching and pain as much as possible, usually with topical and oral medications. The nerve pain (post-herpetic neuralgia) that lingers after the skin clears is the most difficult to treat. There are no therapies to prevent it.
• When bathing, wash blisters gently.
• Don't bandage the sores.
• Apply cool, moist compresses if this decreases the pain.
• Soak in a tub of water to which cornstarch or colloidal oatmeal (Aveeno) has been added.
• Other pain remedies have been advocated, but none has been shown to be consistently effective. These include skin stimulation by intermittent rubbing, use of alternating electrical currents passed through the skin, local heat, cold spraying, and surgical cutting of nerves.

MEDICATION--

• Use calamine lotion for the blisters.
• For minor discomfort, you may use non-prescription drugs such as acetaminophen.
• Your doctor may prescribe: Stronger pain relievers if needed. Tranquilizers for a short time. Cortisone drugs to relieve pain in severe cases. Acyclovir (an antiviral drug). Injections of nerve block in severe cases.

ACTIVITY--No restrictions. Avoid chilling drafts.

DIET--No special diet. Maintain a nutritious diet. Use supplemental vitamins if recommended.

Call Your Doctor If

• You or a family member has symptoms of herpes zoster.
• Pain is intolerable, despite treatment.
• New, unexplained symptoms develop.