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MSRA Dermatology [3] > [18] Shingles > Flashcards

[18] Shingles Flashcards

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Dermatology Board Prep flashcards
1
Q

What is shingles?

A

A viral disease caused by the human herpes virus 3 (HHV-3)

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2
Q

What is HHV-3 more commonly known as?

A

Varicella zoster virus (VZV)

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3
Q

When does shingles occur after infection with VZV?

A

After reactivation of primary infection that usually occurs during childhood

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4
Q

What does primary infection with VZV cause in children?

A

Chickenpox

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5
Q

What happens to the VZV after chickenpox has occurred?

A

It lays dormant in the sensory nervous system

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6
Q

What part of the sensory nervous systems does VZV lat dormant in?

A

The geniculate, trigeminal or dorsal root ganglia

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7
Q

How long can VZV lay dormant for?

A

Decades

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8
Q

What will happen when VZV is reactivated?

A

It will flare up in a single dermatome segment

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9
Q

How does VZV affect the dermatome?

A

It travels down the affected nerves over a period of 3-4 days, causing perineural and intraneural inflammation

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10
Q

What are the most commonly affected areas by shingles in immunocompetent patients?

A
  1. Thoracic nerve roots

2. Ophthalmic division of CN V

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11
Q

What is the danger of ophthalmic shingles?

A

It can progress to involve the entire eye

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12
Q

What things are associated with flare-ups of VZV causing shingles?

A
  • Ageing
  • Immunosuppressive illness
  • Psychological or physical trauma
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13
Q

What age are most patients with shingles?

A

Over 50

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14
Q

What immunosuppressive illnesses can lead to flare up of shingles?

A
  • HIV
  • Hodgkin’s lymphoma
  • Bone marrow transplants
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15
Q

What phases can shingles be divided into?

A
  • Pre-eruptive phase
  • Eruptive phase
  • Chronic phase
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16
Q

What happens in the pre-eruptive phase of shingles?

A
  • No skin lesions
  • Burning, itching or paraesthesia in one dermatome
  • Systemic symptoms
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17
Q

What systemic symptoms can be present in the eruptive phase of shingles?

A
  • Malaise
  • Myalgia
  • Headache
  • Fever
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18
Q

What happens in the eruptive phase of shingles?

A
  • Skin lesions appear

- Acute neuritic pain

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19
Q

How do shingles lesions first appear?

A

As a patch of eryhtematous, swollen plaques with clusters of small vesicles affecting only one dermatome

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20
Q

What happens to shingles lesions over 7-10 days?

A

Crusting and drying

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21
Q

How long can resolution of shingles take?

A

14-21 days

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22
Q

When are shingles lesions no longer infectious?

A

Once the lesions have dryed

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23
Q

Who has a longer and more extensive eruptive phase of shingles?

A

Elderly and immunocompromised patients

24
Q

What can happen as a result of shingles in older and immunocompromised patients?

A
  • Haemorrhagic blisters
  • Skin necrosis
  • Secondary bacterial infections
25
Q

What happens in the chronic phase of shingles?

A

Persisting or recurring pain lasting 30 days+ after acute infection or after all lesions have crusted

26
Q

What percentage of shingles cases are ophthalmic?

A

10-20%

27
Q

What is the biggest risk of ophthalmic shingles?

A

It can be a threat to sight

28
Q

What are the features of ophthalmic shingles?

A
  • Lesions of the orbit or globe within 3 weeks of rash
  • Rash may show Hutchingson’s sign
  • Red eye
  • Decreased visual acuity
  • Epiphora
  • Photophobia
  • Forehead tenderness
29
Q

What is Hutchingson’s sign in shingles?

A

The tip of the nose is affected

30
Q

What does tip of nose involvement in shingles mean?

A

There is involvement of the nasociliary branch of the trigeminal nerve

31
Q

What does the nasociliary branch of the trigeminal nerve also supply?

A

The globe

32
Q

How is shingles diagnosed?

A

Clinically based on the dermatomal lesion

33
Q

If shingles is suspected and there is extension beyond one dermatome what will the patient need to be investigated for?

A

Immunodeficiency

34
Q

What are the differentials for shingles?

A
  • Contact dermatitis
  • Herpes simplex
  • Eczema herpeticum
  • Atopic eczema
  • Impetigo
35
Q

What are the general management precautions in shingles?

A
  • Keep rash clean and dry
  • Cover if possible
  • Avoid work/school if lesions are not dry or cannot be covered
36
Q

What topical medications are used in shingles?

A
  • Topical antibiotic if secondary bacterial infection

- Topical antiviral is not recommended

37
Q

What oral medication is used for shingles?

A

Oral antiviral e.g. acivlovir

38
Q

When should oral aciclovir be started for shingles?

A

Within 72 hours if any of:

  • Over 50
  • Non-truncal involvement
  • Moderate to severe pain
  • Ophthalmic involvement
  • Immunocompromised
39
Q

If aciclovir cannot be started within 72 hours for shingles what should be done?

A

Consider starting up to 1 week after onset especially if at risk of complications

40
Q

What are the first line analgesics for pain caused by shingles?

A

Paracetamol and NSAIDs

41
Q

What are the second-line analgesics for shingles?

A
  • TCA’s
  • Gabapentin
  • Pregabalin
  • Steroids
  • Opioids
42
Q

What are the additional treatment options for intraocular involvement of shingles?

A
  • Ocular lubricants
  • Cycloplegics
  • IV antivirals
  • Topical steroids
  • Intravitreal antiviral therapy
43
Q

What are cycloplegics used for in intraocular shingles?

A

Pain relief

44
Q

When may IV antivirals be required in intraocular shingles?

A
  • Retinitis
  • Choroiditis
  • Optic neuritis
45
Q

What is the most common complication of shingles?

A

Post-herpetic neuralgia

46
Q

What is post-herpeticum neuralgia?

A

Chronic pain along the cutaneous nerves and sometimes distortion of sensation

47
Q

What are other general complications of shingles?

A
  • Skin complications
  • Ramsay Hunt Syndrome
  • Bell’s Palsy
  • Meningitis or encephalitis
  • Disseminated zoster
48
Q

What are the potential skin complications of shingles?

A
  • Scarring
  • Pigmentation
  • Secondary bacterial infection
49
Q

What is Ramsay Hunt Syndrome?

A

A syndrome of; shingles lesions in the ear, facial paralysis, and associated hearing and vestibular symptoms

50
Q

When does disseminated zoster occur?

A

Mainly In Immunocompromised patients

51
Q

What can disseminated zoster lead to?

A
  • Pneumonia
  • Encephalitis
  • Hepatitis
52
Q

What are the potential complications of ophthalmic shingles?

A
  • Ocular complications
  • Lid complications
  • Long-term complications
53
Q

What are the potential ocular complications of ophthalmic shingles?

A
  • Pain
  • Anterior uveitis
  • Keratitis
54
Q

What are the potential lid complications of shingles?

A
  • Ptosis
  • Trichiasis
  • Scarring of the skin
55
Q

What are the potential long-term complications of ophthalmic shingles?

A
  • Poor sensation of cornea

- Poor motor function of the eyelid

MSRA Dermatology [3] (26 decks)

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