Herpes Zoster

Herpes zoster is an acute vesicular eruption due to the varicella-zoster virus. It usually occurs in adults. With rare exceptions, patients suffer only one attack. Dermatomal herpes zoster does not imply the presence of a visceral malignancy. Generalized disease, however, raises the suspicion of an associated immunosuppressive disorder such as Hodgkin's disease or HIV infection. HIV-infected patients are 20 times more likely to develop zoster, often before other clinical findings of HIV disease are present. A history of HIV risk factors and HIV testing when appropriate should be considered, especially in zoster patients under 55 years of age.

Complications of Herpes Zoster

Sacral zoster may be associated with bladder and bowel dysfunction. Persistent neuralgia, anesthesia or scarring of the affected area following healing, facial or other nerve paralysis, and encephalitis may occur. Postherpetic neuralgia is most common after involvement of the trigeminal region, and in patients over the age of 55. Early (within 72 hours after onset) and aggressive antiviral treatment of herpes zoster reduces the severity and duration of postherpetic neuralgia. Zoster ophthalmicus (V1) can result in visual impairment.

Symptom of Herpes Zoster

The principal symptoms are burning and stinging. Neuralgia may precede or accompany attacks. The lesions consist of small, grouped vesicles that can occur anywhere but which most often occur on the vermilion border of the lips, the penile shaft, the labia, the perianal skin, and the buttocks. Regional lymph nodes may be swollen and tender. The lesions usually crust and heal in 1 week. Patients can be educated to recognize attacks that they previously did not identify as recurrences of herpes simplex. Herpes simplex is the most common cause of painful genital ulcerations in patients with HIV infection.

Herpes Zoster Home Treatment -

Since early treatment of zoster reduces postherpetic neuralgia, those with a risk of developing this complication should be treated, ie, those over age 55. In addition, younger patients with acute moderate to severe pain may be benefited by effective antiviral therapy.

Given the safety and efficacy of currently available antivirals, most immunocompromised patients with herpes zoster are candidates for antiviral therapy. The dosage schedule is as listed above, but treatment should be continued until the lesions have completely crusted and are healed or almost healed (up to 2 weeks). Corticosteroids should not be given adjunctively in immunosuppressed hosts since they increase the risk of dissemination.

Diagnosis of Herpes Zoster

The eruption persists 2-3 weeks and usually does not recur. Motor involvement in 2-3% may lead to temporary palsy.