Herpes Zoster - Symptoms and Treatment

Herpes zoster (shingles) is a painful rash caused by the same virus that causes chickenpox. Anyone who has had chicken pox can develop herpes zoster. The virus remains dormant (inactive), in certain nerve cells of the body, and when it reactivates it causes zoster. This reactivation of the virus is most likely to occur in people with a weakened immune system. This includes people with HIV disease, and anyone over 50 years old. Herpes zoster lives in nerve tissue. Outbreaks of shingles start with itching, numbness, tingling or severe pain in a belt like pattern on the chest, back, or around the nose and eyes. In rare cases, herpes can infect the facial or eye nerves. This can cause outbreaks around the mouth, on the face, neck, and scalp, in and around the ear, or at the tip of the nose. Herpes zoster can cause several problems with the eye and surrounding skin that may have long term effects.  Inflammation and scarring of the cornea , along with conjunctivitis (inflammation of the conjunctiva ) and iritis (inflammation of the iris ) are typical problems that require treatment.  In some cases, the retina and optic nerve are involved.  Eye problems caused by severe or chronic outbreaks of herpes zoster may include:  glaucoma , cataract , double vision, and scarring of the cornea and eyelids . Many who experience this infection find it extremely painful. This acutely painful phase usually lasts several weeks; however, some continue to experience pain or neuralgia long after the outbreak has cleared.  This is known as post-herpetic neuralgia. 

Herpes zoster is an acute , localized infection with varicella-zoster virus, which causes a painful, blistering rash. Herpes zoster is also often referred to as shingles. Risk factors for herpes infection include immunodeficiency secondary to cancer, chemotherapy, radiation therapy, or HIV infection. Shingles incidence is high in the elderly (over 60), as well as in any age group of immunocompromised patients. It affects some 1 million people per year in the United States and can involve excruciating pain. Many patients develop a painful condition called postherpetic neuralgia , which is often difficult to manage. In some patients, herpes zoster can reactivate subclinically, with pain in a dermatomal distribution without rash . This condition is known as zoster sine herpete, and may be more complicated, affecting multiple levels of the nervous system and causing multiple cranial neuropathies , polyneuritis , myelitis , or aseptic meningitis . Treatment is generally with antiviral drugs such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). For the antiviral drugs to be effective, patients typically need to begin taking them within 2-3 days of the appearance of the rash.

Causes of Herpes zoster

Common Causes of Herpes zoster :

• The risk of getting shingles increases as you age. People have a hard time fighting off infections as they get older.
• People who have not had chickenpox could become infected with herpes zoster and develop chickenpox.
• Adult or child is exposed to the herpes zoster virus and has not had chickenpox as a child or received the chickenpox vaccine, a severe case of chickenpox may develop rather than shingles.

Symptoms of Herpes zoster

Some common Symptoms of Herpes Zoster :

• Abdominal pain.
• Headache.
• Chills.
• Fever.
• Joint pain.
• Swollen eyelids.
• Loss of eye motion.
• Hearing loss.
• Drooping eyelid ( ptosis ).
• Genital lesions.
• Lymph node swelling.
• Sensitivity to light
• Blurred vision.
• Watery eyes.

Treatment of Herpes zoster

• The standard treatment for shingles is the drug acyclovir, which can be given orally or intravenously in more severe cases.
• Corticosteroids, such as prednisone, may occasionally be used to reduce inflammation and risk of post-herpetic neuralgia. They have been shown to be most effective in the elderly population. Corticosteroids have certain risks that should be considered before using them.
• If bacteria have infected ruptured vesicles, treatment usually includes an appropriate systemic antibiotic. Trigeminal zoster with corneal involvement calls for instillation of idoxuridine ointment or another antiviral agent.
• Secondary condition secondary conditions caused by herpes zoste may require surgery.
• Herpes Zoster can be treated with antivirals,anti-inflammatory medications and aspirin and other analgesics are used to relieve pain.these also reduce the duration of the disease.
• Several creams, gels and sprays are being studied. These provide temporary relief from pain.

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