Herpes Zoster (Shingles)

Herpes zoster (shingles) is an acute unilateral and segmental inflammation of the dorsal root ganglia. It produces localized vesicular skin lesions confined to a dermatome. The patient with shingles may have severe neuralgic pain in the areas bordering the inflamed nerve root ganglia.

The infection is found primarily in adults between age 50 and 70. The prognosis is good, and most patients recover completely unless the infection spreads to the brain. Herpes zoster is more severe in the immuncompromised patient but seldom is fatal. Patients who have received a bone marrow transplant are especially at risk for the infection.

Causes

The varicella-zoster virus, a herpesvirus, causes shingles. For unknown reasons and by an unidentified process, the disease erupts when the virus reactivates after dormancy in the cerebral ganglia (extramedullary ganglia of the cranial nerves) or the ganglia of posterior nerve roots. Although the process is unclear, the virus may multiply as it reactivates, and antibodies remaining from the initial infection may neutralize it. Without opposition from effective antibodies, the virus continues to multiply in the ganglia, destroys neurons, and spreads down the sensory nerves to the skin.

Herpes zoster may be more prevalent in people who had chickenpox at a very young age.

Signs and Symptoms

Herpes zoster most often occurs on the trunk and buttocks. However, it may appear on the arms, legs, or face. The following are the most common symptoms of herpes zoster. However, each child may experience symptoms differently. Symptoms may include:

• skin hypersensitivity in the area where the herpes zoster appears
• mild rash, which appears after five days and first looks like small, red spots that turn into blisters
• blisters which turn yellow and dry
• rash which usually goes away in one to two weeks
• rash is usually localized to one side of the body

The symptoms of herpes zoster may resemble other skin conditions. Always consult your child's physician for a diagnosis.

Diagnostic tests

Vesicular fluid and infected tissue analyses typically show eosinophilic intranuclear inclusions and varicella virus. Differentiation of herpes zoster from localized herpes simplex requires staining antibodies  from vesicular fluid and identification under fluorescent light. Usually, though, the locations of herpes simplex and herpes zoster lesions are distinctly different.

Treatment

In most people with zoster, the condition clears on its own in a few weeks and seldom recurs. Treatment is helpful however. It usually consists of pain relievers as well as cool compresses to help dry the blisters. There are several highly effective medications for zoster. Antiviral pills (Famvir, Zovirax, Valtrex) will only work if started in the first 3 days. Others (Neurontin, Tegretol, Elavil) help the pain that may follow. Injections of cortisone, especially if directly into the area of nerve pain can help ease this pain.

Prevention

Prevention is uncertain. Avoid contact with the skin lesions of persons with known herpes zoster infection (shingles or chickenpox) if you have never had chickenpox or the chickenpox vaccine, or ESPECIALLY if your immune system is compromised.

The chickenpox vaccine (varicella) is a recommended childhood vaccine. The vaccine may be recommended for teenagers or adults who have never had chickenpox.