Herpes Zoster

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Heather Lindsey and Kaycee Stone from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Kaycee Stone, Heather Dixon, Lucinda hampton, Donald John Auson, Kim Jackson, Elaine Lonnemann, Wendy Walker, WikiSysop, Chelsea Mclene, Nupur Smit Shah and Evan Thomas  

Definition/Description

Herpes Zoster, commonly called Shingles, is characterized by a painful rash with blisters.

Prevalence

Shingles will affect 1 in 3 people in the United States, with approximately 1 million cases each year. Half of the people affected are over the age of 60.

Characteristics/Clinical Presentation

At first, there is only pain, tingling, or burning before a rash appears. This is generally on one side of the body. The rash appears as red areas, then blisters that break and form crusts. This rash usually lasts two to three weeks and often affects an area from the spine to the chest or abdomen, as well as the ears, face, or eyes. The rash can be widespread, like chickenpox, in cases involving an immunocompromised patient. Other assosciated symptoms include flu-like symptoms such as fever, chills, malaise, headache, joint pain, and swollen glands. If the eye is affected, the virus can cause blindness.

Associated Co-morbidities

Immunocompromised people, like people undergoing treatment for cancer, leukemia, lymphoma, HIV, and patients on immunosuppressive drugs are at an increased risk of developing shingles. Older adults are also at an increased risk for developing it.

Medications

Acyclovir, valacyclovir, and famciclovir are antiviral medications that are commonly prescribed to treat shingles to shorten the duration and ease the severity of the outbreak. Pain medication may also be prescribed to help with the pain related to shingles. Other medications that are used to treat shingles include steroids and anticonvulsants.

Diagnostic Tests/Lab Tests/Lab Values

The diagnosis is generally made based upon an examination of the skin and taking medical history. A skin sample may be taken to determine if the skin is infected by the varicella-zoster virus. Health care providers may run blood tests, which will not diagnose Herpes Zoster, but will show elevated white blood cells and antibodies to the virus that causes chicken pox.

Etiology/Causes

Herpes Zoster is caused by the dormant varicella zoster, also known as chickenpox, becoming active again, often years following the initial incidence of the infection.

Systemic Involvement

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Medical Management (current best evidence)

Shingles can be treated conservatively using nonsteroidal anti-inflammatory drugs or wet dressings with 5% aluminum acetate. These dressings should be applied for 30-60 minutes and be done 4-6 times each day. Lotions such as calamine can also be used to help relieve symptoms.

The Varicella-zoster virus vaccine is used as a preventative measure for shingles.

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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