viral infection of the nerve cells and surrounding skin, caused by the varicella zoster virus what we basically see in ths conditions what basic things to remember always....

1. ABHISHEK JHA

2.  Herpes zoster/shingles is a viral
infection of the nerve cells and
surrounding skin, caused by the
varicella zoster virus that also
causes chickenpox
 After a person recovers from
chickenpox infection, the virus
remains dormant in the nerve
cells and can reactivate at a later
stage when the immune system is
weakened
 Reactivation can be associated
with older age, having chickenpox
before 18 month of age or
immunosuppression

4. Painful skin rash with blisters involving a limited area.
Typically the rash occurs on either the left or right of the
body or face in a single stripe. Two to four days before
the rash occurs there may be pain or tingling in the area.
Rash usually heals within two to four weeks. some
people develop ongoing nerve pain which may last for
months or years called post herpetic neuralgia.
Exposure to the virus in the blisters can cause
chickenpox in someone who has not had it before but
will not trigger shingles

5. Nonspecific
Headache, fever and malaise
Specific
sensations of burning pain,
itching,
hyperesthesia (oversensitivity)
paresthesia "pins and needles".
Pain can be mild to extreme in the affected
dermatome, with sensations that are often
described as stinging, tingling, aching,
numbing or throbbing, and can be
interspersed with quick stabs of agonizing
pain.

7. Shingles in children is often painless, but people
are more likely to get shingles as they age, and
the disease tends to be more severe
 Usually within a dermatome, a rash will begin to
develop, often causing a pain, itching or tingling
sensation in the area of the affected nerve
 A fluid filled painful rash then develops a few
days after and commonly occurs either on one
side of the face or body
 The rash forms blisters that typically scab over in
7-10 days and this eventually clears within 2-4
weeks.

8. Later the rash becomes vesicular, forming
small blisters filled with a serous exudate,
as the fever and general malaise continue.
The painful vesicles eventually become
cloudy or darkened as they fill with blood,
and crust over within seven to ten days;
usually the crusts fall off and the skin heals,
but sometimes, after severe blistering,
scarring and discolored skin remain

10. The ophthalmic division of the trigeminal nerve is
most commonly involved branch. When the virus
is reactivated in this nerve branch it is termed
zoster ophthalmicus. The skin of the forehead,
upper eyelid and orbit of the eye may be involved.
Shingles oticus, also known as Ramsay Hunt
syndrome type II, involves the ear. It is thought to
result from the virus spreading from the facial
nerve to the vestibulocochlear nerve. Symptoms
include hearing loss and vertigo (rotational
dizziness)

12. Due the close
relationship of blood
vessels to nerves, the
virus can easily spread
to involve the blood
vessels and compromise
the blood supply,
sometimes causing
ischemic necrosis

13. Pain radiating along the path of a single
spinal nerve (a dermatomal distribution),
but without an accompanying rash.
This condition may involve complications
that affect several levels of the nervous
system and cause many cranial
neuropathies, polyneuritis, myelitis, or
aseptic meningitis.
Other serious effects that may occur in
some cases include partial facial paralysis
(usually temporary), ear damage or
encephalitis

14. Typically resolves within 3–5 weeks, certain
complications may arise:
Secondary bacterial infection
Motor involvement, including weakness especially in
"motor herpes zoster"
Eye involvement: trigeminal nerve involvement (as seen in
herpes ophthalmicus) should be treated early and
aggressively as it may lead to blindness. Involvement of
the tip of the nose in the zoster rash is a strong predictor
of herpes ophthalmicus.
Post herpetic neuralgia a condition of chronic pain
following shingles.

15. 1. Visual Examinations
rash in a dermatomal
pattern
2. Laboratory tests
IgM antibody in blood;
this appears only during
chickenpox or shingles
and not while the virus
is dormant
3. PCR
4. viral culture

16. 1. Analgesic
Calamine= an be used on the rash
or blisters and may be soothing.
Zostrix cream Once the lesions have
crusted over, can be used.
Morphine ,Topical lidocain reduce
pain.
2. Antiviral
acyclovir, valaciclovir
3 Steroids
corticosteroids for short term