Let's talk about Shingles or Herpes zoster!
∆After initial infection, VZV persists in latent form in the dorsal root ganglion of sensory nerves and can reactivate in later life.
∆Burning discomfort occurs in the affected dermatome following reactivation and discrete vesicles appear 3–4 days later.
∆This is associated with a brief viraemia, which can produce distant satellite ‘chickenpox’ lesions.
∆Occasionally, paraesthesia occurs without rash (‘zoster sine herpete’).
∆Severe disease, a prolonged duration of rash, multiple dermatomal involvement or recurrence suggests underlying immune deficiency, including HIV.
∆Chickenpox may be contracted from a case of shingles but not vice versa
∆Although thoracic dermatomes are most commonly involved the ophthalmic division of the trigeminal nerve is also frequently affected; vesicles may appear on the cornea and lead to ulceration. This condition can lead to blindness and urgent ophthalmology review is required.
∆Geniculate ganglion involvement causes the Ramsay Hunt syndrome of facial palsy ipsilateral loss of taste and buccal ulceration, plus a rash in the external auditory canal.
∆This may be mistaken for Bell’s palsy. Bowel and bladder dysfunction occur with sacral nerve root involvement.
∆The virus occasionally causes cranial nerve palsy, myelitis or encephalitis. Granulomatous cerebral angiitis is a cerebrovascular complication that leads to a stroke-like syndrome in association with shingles, especially in an ophthalmic distribution.
∆Post-herpetic neuralgia causes troublesome persistence of pain for 1–6 months or longer, following healing of the rash. It is more common with advanced age
Treatment:
∆∆These drugs are used.
✓Aciclovir
✓Famciclovir
✓Valaciclovir
∆∆Post Herpetic Neuralgia: This should be treated agressively with
✓Amitriptyline
✓Gabapentin
✓Pregabelin
✓Capsacin cream may help.
Thanks for today
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