Herpes Zoster

Question 1

What is the typical history associated with herpes zoster?

Answer 1

Painful, unilateral vesicular rash in a dermatomal distribution. History of varicella (chickenpox). Prodromal pain, itching, or tingling.

Question 2

What are the key physical examination findings in herpes zoster?

Answer 2

Vesicular rash along a dermatome, typically not crossing the midline. Erythema and swelling. Possible postherpetic neuralgia.

Question 3

What investigations are necessary for diagnosing herpes zoster?

Answer 3

Clinical diagnosis based on history and physical exam. PCR or direct fluorescent antibody (DFA) test of vesicular fluid. Serology for varicella-zoster virus (VZV) antibodies.

Question 4

What are the non-pharmacological management strategies for herpes zoster?

Answer 4

Keep rash clean and dry. Cool compresses to alleviate discomfort. Educate on avoiding contact with pregnant women, infants, and immunocompromised individuals.

Question 5

What are the pharmacological management options for herpes zoster?

Answer 5

Antiviral therapy (e.g., acyclovir, valacyclovir) within 72 hours of rash onset. Analgesics for pain management. Corticosteroids in severe cases.

Question 6

What are the red flags to look for in herpes zoster patients?

Answer 6

Severe pain not managed by standard treatments. Signs of disseminated infection: widespread rash, fever. Ocular symptoms: immediate referral to ophthalmology if ocular involvement.

Question 7

When should a patient with herpes zoster be referred to a specialist?

Answer 7

Ocular involvement requiring immediate referral to ophthalmology. Severe or disseminated infection. Persistent or severe pain (postherpetic neuralgia).

Question 8

What is one key piece of pathophysiology related to herpes zoster?

Answer 8

Reactivation of varicella-zoster virus (VZV) from dorsal root ganglia. Causes inflammation and damage along affected nerve. Can lead to postherpetic neuralgia.