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Herpes Zoster

Shingles

Herpes zoster is a condition characterized by development of skin rash with blisters. It is a viral disease that promotes development of rash only on one side of the body.


Presentation

Pain is the preliminary sign of herpes zoster. Few days later, skin rashes develop only on one side of the body affecting one or more skin dermatomes. In many cases, the rash develops on the left or right side of the torso. However, many individuals may develop the rash on one side of the neck or face or around the eyes. In addition to these, other signs and symptoms of herpes zoster include the following [7]:

  • Burning accompanied by tingling sensation in the affected area
  • Pruritic rashes 
  • Skin rash with blisters that break and develop crust
  • Individuals with herpes zoster also suffer from fever, fatigue and headache
Fever
  • The typical clinical manifestation is an acute segmental eruption of herpetiform umbilicated vesicles associated with malaise, pain, dysaesthesia, allodynia and probably fever.[ncbi.nlm.nih.gov]
  • The morphology of the lesions included erythematous papules, pseudovesicles, and plaques, with associated pain in two and pruritus in three patients; systemic symptoms ranged from none to low-grade fevers, upper respiratory symptoms, and joint pain.[ncbi.nlm.nih.gov]
  • Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster.[ncbi.nlm.nih.gov]
  • Symptoms of shingles include: A painful rash and blisters on 1 side of the face or body Fever Headache Chills Upset stomach Shingles can’t spread from person to person like chickenpox.[vaccines.gov]
  • In addition, certain percentage of affected population may also experience fever along with general weakness. Diagnosis No laboratory studies or imaging tests are useful in diagnosis of herpes zoster.[symptoma.com]
Chills
  • You begin to have symptoms of a secondary infection, such as a very high fever, chills, and severe headache. Thanks for your feedback![verywell.com]
  • Other symptoms of herpes zoster include flu-like symptoms, fever, chills, a headache, and intense fatigue. How is Herpes Zoster Diagnosed? Dr. Vivian Bucay often only requires a brief physical examination for her to diagnosis herpes zoster.[drvivianbucay.com]
  • […] rash, which can appear up to five days after and first looks like small, red spots that turn into blisters Blisters which turn yellow and dry Rash which usually goes away in two to four weeks Rash is usually localized to one side of the body Fever, chills[chop.edu]
  • You may also feel: A tingling feeling in or under your skin Fever, chills, and headache An upset stomach The rash eventually turns into painful, red, fluid-filled blisters . They should begin to dry out and crust over within 7 to 10 days.[webmd.com]
  • Symptoms of shingles include: A painful rash and blisters on 1 side of the face or body Fever Headache Chills Upset stomach Shingles can’t spread from person to person like chickenpox.[vaccines.gov]
Malaise
  • The typical clinical manifestation is an acute segmental eruption of herpetiform umbilicated vesicles associated with malaise, pain, dysaesthesia, allodynia and probably fever.[ncbi.nlm.nih.gov]
  • It is frequently associated with fever, malaise, headache, and pain in the area of the rash. The vesicles typically crust and heal within 2 to 6 weeks.[nyee.edu]
  • This is a strong predictor of ocular inflammation and corneal denervation in HZO, especially if both branches of the nasociliary nerve are involved. [10] [11] Symptoms Many cases of HZO exhibit a prodromal period of fever, malaise, headache, and eye pain[eyewiki.aao.org]
  • It is a highly contagious disease characterized by a widespread papulovesicular eruption with fever and malaise. 1,2 After the primary infection, the virus remains latent within the sensory dorsal root ganglia and can reactivate as herpes zoster (HZ).[mdedge.com]
  • […] more than a half of cases occur before the age of 60 Immune compromise: HIV/AIDS, medical immunosuppression Symptoms Pain and altered sensation of the forehead on one side Rash affecting forehead and upper eyelid appears a day to a week later General malaise[college-optometrists.org]
Fatigue
  • In addition, shingles may cause headache, fatigue, fever, and a general achy feeling. Individuals experiencing the aforementioned symptoms should seek medical attention.[illinoisderm.com]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: November 25, 2018[patientslikeme.com]
  • Here are some of those things: illness or disease (such as HIV or other diseases of the immune system) fatigue or exhaustion stress or anxiety poor nutrition chemotherapy or radiation therapy certain medicines that suppress your immune system, such as[aao.org]
  • […] other signs and symptoms of herpes zoster include the following: Burning accompanied by tingling sensation in the affected area Pruritic rashes Skin rash with blisters that break and develop crust Individuals with herpes zoster also suffer from fever, fatigue[symptoma.com]
  • Other symptoms of herpes zoster include flu-like symptoms, fever, chills, a headache, and intense fatigue. How is Herpes Zoster Diagnosed? Dr. Vivian Bucay often only requires a brief physical examination for her to diagnosis herpes zoster.[drvivianbucay.com]
Lymphadenopathy
  • , fever Signs Skin features: unilateral painful, red, vesicular rash on the forehead and upper eyelid, progressing to crusting after 2-3 weeks; resolution often involves scarring periorbital oedema (may close the eyelids and spread to opposite side) lymphadenopathy[college-optometrists.org]
  • […] tolerate herpes zoster much better than adults, with the disease usually being mild and lasting 1 to 3 weeks. 7 , 9 Clinical features include pruritus and pain, with rare postherpetic neuralgia. 4 , 7 , 20 Systemic reactions include fever, headache, and lymphadenopathy[jamanetwork.com]
  • […] sciatica Other symptoms, such as malaise, myalgia, headache, photophobia, and, uncommonly, fever The acute eruptive phase is marked by the following: Patchy erythema, occasionally accompanied by induration, in the dermatomal area of involvement Regional lymphadenopathy[emedicine.medscape.com]
Abdominal Pain
  • One day after the procedure, the abdominal pain disappeared. In addition, 5 days after the intervention, the abdominal protrusion and constipation were resolved. He currently remains symptom free at a 6 month follow-up.[ncbi.nlm.nih.gov]
  • The most common side effects include headache, abdominal pain, vomiting and diarrhea. The treatment may also provide more serious symptoms such as confusion, hallucinations and affected alertness.[firstderm.com]
  • The most commonly reported side effects are: headache gastrointestinal discomfort (vomiting, nausea, diarrhoea, constipation, abdominal pain, indigestion) You should tell your doctor or pharmacist if they become severe or troublesome.[news-medical.net]
Chest Pain
  • Five days before, the patient was evaluated for left axillary chest pain and nausea. The finding on the initial workup was negative. His medical history included type 2 diabetes mellitus complicated by peripheral neuropathy.[journals.lww.com]
Back Pain
  • Tell your doctor or pharmacist if you notice any of the following and they worry you: dry mouth fever difficulty sleeping chills back pain nervousness skin rash which may be itchy weakness Some rare side effects of VACLOVIR include: sensitivity to UV[news-medical.net]
Eye Pain
  • This is a strong predictor of ocular inflammation and corneal denervation in HZO, especially if both branches of the nasociliary nerve are involved. [10] [11] Symptoms Many cases of HZO exhibit a prodromal period of fever, malaise, headache, and eye pain[eyewiki.aao.org]
  • The rash may never appear as a diagnostic guide in elderly patients with dermatomal pain alone (“zoster sine herpete”); acute facial palsy, hearing loss, vertigo, or dysgeusia (cranial neuritis); blurred vision and eye pain (acute retinal necrosis); and[academic.oup.com]
Blister
  • A hearing examination demonstrated mild-to-moderate left neurosensory hearing loss.Since then, she is having short episodes of redness on her face without pain or sweating at the exact distribution of the zoster blisters 6 years ago.[ncbi.nlm.nih.gov]
  • Definition Herpes zoster is a viral infection characterized by development of skin rashes with blisters specifically on one side of the body. The rash is confined to a small portion and appears as a single strap of blisters.[symptoma.com]
  • This is by the appearance of the blisters and pain on one side of the body.[healthhub.sg]
  • Shingles blisters are usually very painful, and often require prescription painkillers. The pain usually will diminish as blisters heal; however, it can still last for months.[rxlist.com]
Eruptions
  • The time of complete resolution of pain, time of healing of skin eruption, and incidence of PHN were reported.[ncbi.nlm.nih.gov]
  • Acute inciting events for this eruption are not always known, but can include illness, stress, and mechanical injury.[ncbi.nlm.nih.gov]
  • The typical clinical manifestation is an acute segmental eruption of herpetiform umbilicated vesicles associated with malaise, pain, dysaesthesia, allodynia and probably fever.[ncbi.nlm.nih.gov]
  • Either strain may cause a latent infection and subsequent eruption of HZ. We present a case of HZ in a 15-month-old boy after receiving the varicella vaccination at 12 months of age.[ncbi.nlm.nih.gov]
  • Fluorosis Fusion Gemination Hyperdontia Hypodontia Maxillary lateral incisor agenesis Impaction Wisdom tooth impaction Macrodontia Meth mouth Microdontia Odontogenic tumors Keratocystic odontogenic tumour Odontoma Dens in dente Open contact Premature eruption[en.wikipedia.org]
Vesicular Rash
  • Its reactivation results in herpes zoster, otherwise known as shingles, which is a painful vesicular rash in a dermatomal distribution. We present a case of foraminal disk extrusion that resulted in radicular pain in a dermatomal distribution.[ncbi.nlm.nih.gov]
  • In both cases, the orbital syndrome developed prior to the vesicular rash. These cases highlight the need to consider Herpes Zoster ophthalmicus in patients with orbital syndrome not responding to conventional treatment.[ncbi.nlm.nih.gov]
  • Women ages 50 years and older are at risk for herpes zoster, a reactivated virus from varicella zoster virus (chickenpox) that causes a painful vesicular rash and can result in postherpetic neuralgia.[ncbi.nlm.nih.gov]
  • We report the case of a 20-year-old woman with a history of systemic lupus erythematosus (SLE) and DLE who developed a painful, multidermatomal, vesicular rash on the left breast and back consistent with herpes zoster (HZ) during treatment with systemic[ncbi.nlm.nih.gov]
  • The active stage of the disease is characterized by the appearance of a vesicular rash. Postherpetic neuralgia is a common complication of herpes zoster after resolution of the facial and intraoral symptoms.[ncbi.nlm.nih.gov]
Eczema
  • […] affects around 25% of patients and is: chronic and severe in about 7% Complications can occur months or years after the acute phase Differential diagnosis Ocular lesions: herpes simplex keratitis Cutaneous lesions: cellulitis, contact dermatitis, atopic eczema[college-optometrists.org]
Facial Pain
  • The medical term for head or facial pain due to shingles is "painful trigeminal neuropathy attributed to herpes zoster."[verywell.com]
Neuralgia
  • , management, and prevention of herpes zoster and post-herpetic neuralgia.[ncbi.nlm.nih.gov]
  • After successful treatment with antiviral medication, postherpetic neuralgia developed within the next 2 months. Complete resolution of the neuralgia occurred at the 4-month recall with negligible facial scarring.[ncbi.nlm.nih.gov]
  • Herpes zoster (HZ) can develop into postherpetic neuralgia (PHN), both of which are painful diseases. PHN patients suffer chronic pain and emotional disorders.[ncbi.nlm.nih.gov]
  • This review focuses on other possible clinical manifestations of the disease to sensitize physicians not to overlook HZ since only an early antiviral treatment can reduce the risk of post-zosteric neuralgia.[ncbi.nlm.nih.gov]
  • Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev . 2014;(2):CD006866. 18. Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia.[aafp.org]
Headache
  • In addition, shingles may cause headache, fatigue, fever, and a general achy feeling. Individuals experiencing the aforementioned symptoms should seek medical attention.[illinoisderm.com]
  • It affects the brain and can cause symptoms such as a headache, memory loss, fever, and changes in personality.[verywell.com]
  • Symptoms of shingles include: A painful rash and blisters on 1 side of the face or body Fever Headache Chills Upset stomach Shingles can’t spread from person to person like chickenpox.[vaccines.gov]
  • Headache Side effects typically resolve in 3 to 7 days.[walgreens.com]
Cranial Nerve Involvement
  • nerve involvement caused by herpes zoster oticus herpes zoster otikusa bağlı çoklu alt kraniyal sinir tutulumu 5 Medical occipital neuralgia following thoracic herpes zoster torasik herpes zoster sonrası gelişen oksipital nevralji 6 Medical patients[tureng.com]
  • nerve involvement then the patient may experience hearing or vision loss. [3] Postherpetic neuralgia, which is pain lasting longer than 90 days following the initial herpes zoster rash, was found in 24% of patients in a quality of life study by Drolet[physio-pedia.com]
  • View/Print Table TABLE 1 Ocular and Cranial Nerve Involvement in Herpes Zoster Ophthalmicus Structure involved Signs Time of onset (onset of rash Day 0) Eyelid/conjunctiva Blepharoconjunctivitis Cutaneous macular rash respecting midline and involving[aafp.org]
  • nerve involvement) or the patient is systemically ill hospitalize and treat with acyclovir 10 mg/kg IV q8h for 5 to 10 days. systemic antivirals can be supplemented with aciclovir 3% eye ointment, 5 times daily Analgesia: Oral analgesia — IV analgeisa[lifeinthefastlane.com]
Hyperesthesia
  • Patients will typically experience 1-2 days of pain, itching, and hyperesthesia before the skin lesions are noticed. [3] [1] Prevalence Shingles will affect 1 in 3 people in the United States, with approximately 1 million cases each year. [4] Half of[physio-pedia.com]
  • It is the most frequent complication of herpes zoster, observed in 9-45% of all cases. [4] Most people report a deep burning or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains.[emedicine.medscape.com]
  • ., burning and tingling), dysesthesia (altered or painful sensitivity to touch), allodynia (pain associated with nonpainful stimuli), or hyperesthesia (exaggerated or prolonged response to pain).[nejm.org]
  • […] and 12 percent increases in the prevalence of postherpetic neuralgia at 30 and 60 days, respectively. 10 Within the affected dermatome, patients have a variety of sensory abnormalities in addition to neuropathic pain, including allodynia, a form of hyperesthesia[nejm.org]
Burning Sensation
  • Iris versicolor This remedy is often helpful for herpes zoster infection that is accompanied by stomach problems with burning sensations and nausea. Eruptions may appear especially on the right side of the abdomen.[uofmhealth.org]
  • Signs and Symptoms: Early signs of shingles include a burning sensation or stabbing pain and tingling or itching on the skin. After a few days, a rash or blisters appear usually on one side of the body or face.[conditions.health.qld.gov.au]
  • Post-herpetic neuralgia may be a continuous burning sensation with increased sensitivity in the affected areas or a spasmodic shooting pain. The overlying skin is often numb or exquisitely sensitive to touch.[dermnetnz.org]

Workup

Physical examination of the skin rashes and its characteristics forms the basis of the diagnosis. In addition, history of pain and the appearance of rash on one side of the body confirm herpes zoster. In many instances, tissue scrapings can be cultured for the virus, but such a kind of method is time consuming and delays diagnosis and consequent initiation of treatment.

Laboratory tests are of no importance in diagnosing herpes zoster. Also, no type of imaging studies is indicated in diagnosis of the condition. However, MRI can be carried out in cases when there is development of encephalopathy and myelopathy.

Treatment

Herpes zoster cannot be cured; the symptoms can however be managed with antiviral drugs. These medications also reduce the risk of developing complications. Antiviral drugs such as famciclovir, valacyclovir and acyclovir are prescribed for effective management of the rash and blisters [8].

Along with antiviral drugs, numbing agents such as lidociane are also given in form of cream or gel to be applied on the affected area. In order to control the associated symptoms of herpes zoster, steroid injections can also be administered to shorten the duration of the episode [9].

Prognosis

The prognosis of the disease condition is extremely favorable with the rash that resolves within 10 to 15 days. Children and otherwise healthy individuals have a better prognosis as compared to the elderly population [5]. However, if treatment is not initiated in right time, it can cause debilitating and life threatening complications in the immunocompromised population [6].

Etiology

The virus known as varicella zoster virus (VZV) causes herpes zoster. The VZV virus belongs to the Herpesviridae family. The exact etiology that causes the reactivation of the virus years after initial exposure is not yet known. However, individuals with poor immunity status are known to fall easy prey to this disease. Certain disease conditions such as HIV and cancer can predispose the individual to develop herpes zoster [2].

Epidemiology

It has been estimated that in the US, about 99.5% adult aged 40 years and above are susceptible to reactivation of VZV. An individual of any age group who has suffered varicella early in life is susceptible to develop herpes zoster as they age. It happens probably because of lowered immunity. It has also been reported that, individuals who have suffered an attack of herpes zoster are at an increased risk of developing another attack of the disease later in the life. About 4% individuals are susceptible to develop recurrent attacks of herpes zoster [3].

Sex distribution
Age distribution

Pathophysiology

The causative organism varicella zoster virus causes two discrete disease conditions, varicella and herpes zoster. Herpes zoster majorly occurs in those individuals who have suffered varicella early in their life. It is not a contagious disease, but individuals can pass on the virus to healthy individuals. As a result, the healthy individual would develop varicella and not herpes zoster.

After an episode of varicella, the virus remains in dormant state in the dorsal root ganglion. An attack of herpes zoster occurs, when the virus gets activated for reasons not clearly understood. However, certain factors such as decreased immunity or stress are known to predispose an individual to develop herpes zoster [4].

Prevention

Herpes zoster can be prevented through vaccines namely varicella vaccine and varicella–zoster vaccine. The varicella vaccine used for prevention against chicken pox is now commonly used for children. This vaccine is also recommended for adults also who have never had chicken pox.

The FDA has approved the use of varicella–zoster vaccine for individuals aged 50 years and above. This vaccine significantly decreases the likelihood that individuals would develop herpes zoster. However, this vaccine is not indicated for individuals with weakened immune system [10].

Summary

An episode of herpes zoster is short lived and manifests as skin rashes in children and adults. Individuals who have suffered from varicella (chicken pox) can develop herpes zoster later in life. Once varicella is treated, the virus stays in dormant state inside the body and is not eliminated. Years after the initial exposure, the virus often causes episodes of herpes zoster [1].

Patient Information

Definition

Herpes zoster is a viral infection characterized by development of skin rashes with blisters specifically on one side of the body. The rash is confined to a small portion and appears as a single strap of blisters.

Cause

The virus known as varicella zoster virus causes herpes zoster. Individuals who had suffered from chicken pox early in their life are more prone to develop herpes zoster. The virus stays in dormant state in the body and gets activated when it gets favorable environment to grow. Individuals with poor immunity profile are at an increased risk of developing herpes zoster.

Symptoms

Individuals with herpes zoster develop painful rash along with blisters on one side of the body. In addition, certain percentage of affected population may also experience fever along with general weakness.

Diagnosis

No laboratory studies or imaging tests are useful in diagnosis of herpes zoster. Careful physical examination of the skin rashes and its characteristics helps in establishing a definite diagnosis of the condition.

Treatment

Antiviral agents along with corticosteroids are administered for treatment of herpes zoster. For providing relief from the uncomfortable symptoms of the rashes, numbing agents such as lidocaine are also given to be applied on the affected area.

References

Article

  1. Karlin JD. Herpes zoster ophthalmicus: the virus strikes back. Ann Ophthalmol. Jun 1993;25(6):208-15.
  2. Whitley RJ, Weiss HL, Soong SJ, Gnann JW. Herpes zoster: risk categories for persistent pain. J Infect Dis 1999; 179:9.
  3. Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, et al. Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med. Dec 2005;118(12):1416.
  4. Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med 2002; 347:340.
  5. Tseng HF, Chi M, Smith N, et al. Herpes zoster vaccine and the incidence of recurrent herpes zoster in an immunocompetent elderly population. J Infect Dis 2012; 206:190.
  6. Schmader K, George LK, Burchett BM, Pieper CF. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis. Nov 1998;178 Suppl 1:S67-70.
  7. Dolin R, Reichman RC, Mazur MH, Whitley RJ. NIH conference. Herpes zoster-varicella infections in immunosuppressed patients. Ann Intern Med 1978; 89:375.
  8. Wood MJ, Shukla S, Fiddian AP, Crooks RJ. Treatment of acute herpes zoster: effect of early (< 48 h) versus late (48-72 h) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis. Nov 1998;178 Suppl 1:S81-4.
  9. Fernandes NF, Malliah R, Stitik TP, Rozdeba P, Lambert WC, Schwartz RA. Herpes zoster following intra-articular corticosteroid injection. Acta Dermatovenerol Alp Panonica Adriat. Mar 2009;18(1):28-30.
  10. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271.

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Last updated: 2018-06-22 11:51