Herpes Zoster
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[edit | edit source]
Herpes Zoster, commonly called Shingles, is characterized by a painful rash with blisters.[1] It results from dorment varicella-zoster virus that reactivates within sensory ganglia. The severity increases with advancing age.[2]
Prevalence[edit | edit source]
Shingles will affect 1 in 3 people in the United States, with approximately 1 million cases each year.[3] Half of the people affected are over the age of 60.[3]
Characteristics/Clinical Presentation
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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.[1] The rash can be widespread, like chickenpox, in cases involving an immunocompromised patient.[3] Other assosciated symptoms include flu-like symptoms such as fever, chills, malaise, headache, joint pain, and swollen glands.[1] If the eye is affected, the virus can cause blindness.[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 et al. Acute pain and postherpetic neuralgia were most commonly associated with anxiety, depression, difficulty sleeping, and decreased ability to participate in activities of daily living.[4]
Associated Co-morbidities[edit | edit source]
Immunocompromised people, like people undergoing treatment for cancer, leukemia, lymphoma, HIV, and patients on immunosuppressive drugs are at an increased risk of developing shingles.[3] Older adults are also at an increased risk for developing it.[3]
Medications[edit | edit source]
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.[3] Other medications that are used to treat shingles include steroids and anticonvulsants.[5]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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.[1]
Etiology/Causes[edit | edit source]
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.[1]
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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.[5]
The Varicella-zoster virus vaccine is used as a preventative measure for shingles.[5] A literature update by Dworkin et al. for recommendations for pharmacological management of neuropathic pain suggests that implementation of the vaccine as a preventative intervention decreases the risk of developing herpes zoster by half, and thus, reduces the risk of neuropathic pain.[6]
Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 PubMed Health. Shingles: herpes zoster. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001861/ (accessed 4 March 2014).
- ↑ Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A Vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271-84.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Centers for Disease Control. Shingles (herpes zoster). http://www.cdc.gov/shingles/about/index.html (accessed 4 March 2014).
- ↑ Drolet M, Brisson M, Schmader KE,Levin MJ,Johnson R,Oxman MN, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. CMAJ 2010; 182: 1731-6.
- ↑ 5.0 5.1 5.2 Medscape. Herpes zoster treatment & management. http://emedicine.medscape.com/article/1132465-treatment (accessed 13 Mar 2014).
- ↑ Dworkin RH, O'Connor AB, Audette J, Baron R, Gourlay GK, Haanpaa ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010;85(Suppl 3):S3-S14.
