Herpes Zoster

Herpes zoster also known as Shingles or zoster is a viral skin disease, characterized by painful skin rashes, sometimes with blisters in localized areas in the body. It starts with a tingling or abnormal pain then later a rush occurring in single stripes on the left or right side of the body or face. In some cases, the rush is likely to heal within four weeks, while in other rare cases one develops postherpetic neuralgia, which occurs as a prolonged pain in the nerves for years. Herpes zoster is mainly caused by the reactivation of Varicella Zoster Virus (VZV) in the body, where it travels from the body’s nerve to the skin causing blisters. People likely to get affected by this virus are the old, those with poor immune function, and those who have chickenpox before they are 18 months old (Lu & Xue, 2017).
Common Signs and Symptoms
Some early signs of Herpes Zoster include fever, malaise, and headache, which are non-specific and are most likely to give the wrong diagnosis. After these symptoms, a sensation of burning pain and itching along an unusual oversensitivity called hyperesthesia and the feeling of tingling and numbness “pins and needles”, starts to occur. Sometimes the pain is severe in the affected area with aching and throbbing sensations and even made worse by stabs of agonizing pain (Lu & Xue, 2017). Herpes zoster is painless in children but when one gets it, it becomes painful and more severe as one grows old. After a short period, an appearance of the characteristic skin rash occurs, mainly on the torso and sometimes the face and eyes. It initially occurs just like the first appearance but later changes the skin to like a dermatome hence resulting in a stripe pattern, which is only on one side of the body. Some people get all the other symptoms apart from the skin rash; this is referred to as zoster without herpes. After the development of the characteristic rash, small blisters are formed and the fever becomes worse and the malaise continues. Later the vesicles darken while filled with blood and crust. The crust falls off in most of the cases and the skin heals, while in some cases scarring remains (Bevan & Authors, and Dragons, 2018).
Screening Assessment Tools
In herpes zoster events, the most severe sequel is the postherpetic neuralgia (PHN) (Watson, Gershon, & Oxman, 2017). Old age, pain, skin rash are the risk factors for PHN. Therefore, the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale is used together with the above risk factors to predict PHN. In the screening assessment, patients are asked for their symptoms and signs, their demographic information, and the intensity of their pain using the Visual analog scale (VAS) and the Self-completed Leeds Assessment of Neuropathic Symptoms and signs (S-LANSS). After this, they are followed up to check whether they are suffering from PHN. These tools, therefore, are important while predicting PHN and early management of pain.
Recommended Diagnostic Tests
There are laboratory tests available for diagnosis of herpes zoster. One of the most common tests is used to detect the varicella-zoster virus in the blood, and it specifically appears when the virus is active like during chickenpox and shingles. In other cases, physicians collect lymph from the blisters and test it using the polymerase chain reaction for varicella zoster virus DNA. Sometimes the lymph collected is examined using an electron microscope to look for virus particles. In addition, there are molecular tests, which are mainly based on vitro nucleic acid amplification. These PCR tests are considered most reliable tests. There are two types of PCR tests, the Nested PCR, which has a very high sensitivity and very liable to contamination hence could easily lead to false results. The second test is the Real-time PCR tests, which are rapid, simple to perform and are highly sensitive just like the nested PCR tests. However, the Real-time PCR tests are not prone to contamination like the Nested PCR tests even though their sensitivity is much higher than the viral cultures (Watson, Gershon, & Oxman, 2017).
Treatment Plans
The objective of treatment of herpes zoster is to reduce the period of pain, the related complications and the duration of an episode of shingles. Firstly, people who only have little to moderate pain can easily be treated using over the desk painkillers and lotions containing calamine used on the rash. When the pain persists, one can use topical lidocaine and nerve blocks, an opioid medication such as morphine can be used, and capsaicin cream on the crusted lesions. For postherpetic neuralgia, it may be relieved by antivirals, while gabapentin is administered along with antivirals. However, antivirals do not prevent postherpetic neuralgia but can be used in the reduction of the duration of shingles. To reduce complications in immune-compromised patients, intravenous acyclovir is used. Individuals with high risks of shingles attack also take acyclovir as a five-day daily dose. To decrease long term pain, corticosteroids are used and they also have a minimal rate of side effects (Rodgers, 2016).

Watson, C. P. N., Gershon, A. A., Oxman, M. N. (2017). Herpes Zoster: Postherpetic Neuralgia and other complications: focus on treatment and prevention. New York: Springer Publishing.
Lu, C., Xue, C. C. (2018). Evidence-based clinical Chinese medicine – volume 6: Herpes Zoster and Post-Herpetic Neuralgia. Singapore: world scientific publishers.
Bevan, B., Authors, and Dragons. (2018). It came from my butthole. Canada: Amazon digital services.
Rodgers, A. (2016). Shingles: Natural Home Treatment Remedies. New York: Create space independent publishers.

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