Shingles (herpes zoster) Skin Condition : What Is It ? Treatment and Advice For Patient !
Shingles occurs in people who have previously had chickenpox. The virus lies dormant in the dorsal root ganglion; when reactivated, it travels down the cutaneous nerves to infect the epidermal cells.
Approximate age group
Can occur at any age.
Presentation
There is pain, tenderness or an abnormal sensation in the skin for several days before the rash appears. The rash will form groups of small vesicles on an erythematous background, followed by weeping and crusting. The rash is usually unilateral with dermatomal distribution and a sharp cut off at or near the midline. This feature and associated pain makes any other diagnosis unlikely. The pain often continues until healing occurs but may go on for months or even years in older people (post-herpetic neuralgia).
Treatment
If the patient is seen in the prodromal phase with pain or abnormal sensation, or within 48 hours of the blisters appearing, treat with a 7-day course of an oral antiviral agents such as Aciclovir, Valaciclovir or Famciclovir.
Antiviral agents are only effective when the virus is replicating and should only be given in the early phase of the disease (within 48 hours of the rash appearing).
Adequate analgesia is important, such as paracetamol 1g every 4 hours or co-proxamol 2 tablets 4 hourly. In older people, prophylactic low dose amitriptyline at night, gradually increasing to 75mg, may help postherpetic neuralgia if started as soon as the rash appears.
Advice to patient
Reassure the patient that shingles cannot be caught, but chickenpox can be contracted from a patient with shingles by someone who has never had chickenpox.
Traffic light
If there is ophthalmic involvement, rapid referral to ophthalmology is required to minimise potential complications of shingles involvement of the eye.
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Shingles Skin Condition, Natural Treatment, Advice Skin Condition
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