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Acute Herpes Zoster
(Shingles)
Acute Herpes
Zoster is a
viral disease,
which involves a
dorsal root
ganglion (or
ganglia) and its
peripheral nerve
(or nerves). The
disease
is usually
painful and is
self-limiting.
The virus is
identical to the
virus
causing
varicella
(chicken pox).
Varicella is a
primary
infection with
this
virus, whereas
Zoster is a
secondary
infection due to
reactivation of the virus.
DIAGNOSIS:
Signs and
symptoms:
Usually the
first symptom of
herpes zoster is
Dysesthesia (an
unpleasant
abnormal
sensation
produced by
normal stimuli),
accompanied by
pain in the area
served by the
peripheral nerve
of the affected
ganglion. The
pain is usually
described as a
dull, burning,
aching, or
shooting pain.
Within a few
days, a rash
develops in the
distribution of
the involved
nerve, the rash
progresses from
macular to
papular and from
papular to
vesicular.
Healing occurs
when the
vesicles become
crusted and the
crusts fall
away, leaving in
some cases
permanent,
depressed,
whitish scars.
The eruptions may
clear in from
10-14 days but
in some cases up
to five weeks.
The lesions may
occur in the
thoracic,
cervical, or
lumbar nerves
and also in the
ophthalmic
division of the
trigeminal
nerve.
The pain of
herpes zoster
usually
disappears with
healing of the
skin lesions,
however, a
common and
dreaded
complication is
persistent pain
or post-herpetic
neuralgia. The
components of
this discomfort
include, burning
or gnawing pain;
paroxysmal
shooting or
shocking pain;
and sharp,
radiating pain
that is produced
by very light
stimulation.
Post herpetic
neuralgia is
more likely to
occur in the
immunosuppressed
and elderly
patients.
Management of
Acute Herpes
Zoster:
Sympathetic
block is a very
effective means
of terminating
acute herpes
zoster and also
in preventing
the development
of post-herpetic
neuralgia if the
blocks are
started early in
the acute phase
of the disease.
Management also
includes the use
of antiviral
medications,
such as
Acyclovir, which
is effective in
reducing the
length of time
of the acute
outbreak of the
lesions and in
decreasing the
pain and
promoting
healing.
The discomfort
may also be
treated with
analgesic
medications and
anti-inflammatory
medications,
together with
antidepressants
(such as
Amitriptyline).
Itching may be
relieved by oral
antihistamine
medication or
topical
application of
antihistamine or
cortisone
medication some
advocate the use
of
Corticosteroid
to help control
and shorten the
acute phase, and
perhaps to
reduce the risk
of Post herpetic
neuralgia.
Post Herpetic
Neuralgia:
The treatment of
Post herpetic
neuralgia is
difficult, and
consists of the
use of tricyclic
antidepressants
and analgesic.
Capsaicin is
also of some
benefit when
this topical
agent is applied
four to five
times a day for
several weeks.
Sympathetic
blocks can also
be tried even at
this late stage.
Although there
effectiveness is
greatly reduced
at this stage,
they should be
tried because if
they are
effective even
in one patient
it is 100% for
that individual.
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Author: Robert
V. Plehn, M.D.,
DABA, FACA
Medical Director
DoctorsForPain.com |
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