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ComPbms.Derm
Herpes Zoster
| Question | Answer |
|---|---|
| What | Viral infection caused by the reactivation of the varicella virus. After the initial infection the virus becomes latent in the dorsal root ganglia, it reactivates when the immune system weakens, more common in aging populations but can occur at any age. |
| Physical findings | Pain precedes the skin rash by 3-5 days. Pain is usually localized to the affected dermatome. Constitutional symptoms include HA, malaise, fever. |
| Physical findings | Initial rash is erythematous maculopapules. The maculopapules progress to vesicles which eventually crust and fall off. |
| Physical findings | The usual course takes three weeks but postherpatic nueralgia can last for a few weeks until several months depending on the severity of the outbreak. |
| Physical findings | Optical involvement is considered a medical emergency and must always be referred to an Opthmologist. |
| Physical Findings | Herpes zoster may involve the trigeminal nerve, vesicles on the pinna and external canal cause moderate to severe pain and may results in nerve palsy (facial nerve is most commonly involved). |
| Lab studies | Viral cultures are helpful but not always necessary. Visual confirmation and symptoms will confirm a diagnosis. |
| Treatment (Pain) | Moist compresses may help with crust removal. Pain medication, this is dependant on the patient and their individual condition. Gabapentin 100-600 mg tid as well as tricyclic antidepressants may help with postherpatic nueralgia. |
| Treatment (pain) | Lidocaine patch to healed affected area may also offer pain relief. |
| Treatment (Oral antivirals) | Acyclovir 800mg 5 times daily for 7-10 days, this is a cheap alternative for the patient with financial constraints. Valacyclovir (Valtrex) 1 g tid for 7 days. Famcyclovir (faltrex) 500mg tid for 7 days. |
| Treatment (IV antivirals) | IV acyclovir is recommended for immunocomprised patients , these patients should be referred to the physician. |
| Treatment for special populations | Severe postherpatic nueralgia may require sympathetic blocks. Corticosteroids are recommended for the patient >65, this should be instituted within 72 hours of presentation, this helps with the prevention of postherpatic nueralgia. |
| Disposition | 30% of Americans will experience an postherpatic nueralgia by age 40, 70% by age 70, antivirals will decrease the incidence. Motor neuropathies occur in 5% of all case and usually resolve 70% of the time. |
| Disposition | Always refer suspected optical cases immediately, this is a sight threatening condition. |
Created by:
DianaB
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