Herpes Zoster Flashcards
Liklihood that patient can have a second recurrence of herpes zoster
10-20% of people will have shingles in their lifetime
- once they have an outbreak however, only about 5% will have another attack
Zoster sine herpete
Segmental neuralgia without the cutaneous eruption
Clinical presentation of shingles
Start with red swollen plaques that spread to involve the dermatome
Then get vesicles of varying sizes that become purulent
Opthalmic zoster:
CN V (Trigeminal) - vesicles on side/tip of nose (Hutchinson's sign) are associated with the most serious ocular complications
Ramsey-Hunt Syndrome
peripheral facial nerve palsy accompanied by vesicular rash on the ear (zoster oticus) or mouth
- caused by zoster of the geniculate ganglion
- can also see loss of taste on anterior tongue and auditory nerve involvement
Sacral zoster
can see neurogenic bladder associated with this
Zoster dissemination
Defined as having 20+ vesicles outside of the primary and adjacent dermatomes
DDx of herpes zoster
Herpes simplex
Poison ivy
Zoster sine herpete
Cellulitis (particularly in early phase before vesicles)
Diagnostic test of choice
Tzanck smear (multi-nucleated giant cells)
When is the vaccine recommended
Patients over the age of 50
Indications for antiviral treatment of herpes zoster
Age >50, moderate/severe pain, severe rash, eye or face involvement, immunocompromised state
If acyclovir resistant herpes in the immunocompromised…
Use foscarnet
How to prevent post-herpetic neuralgia
Varying evidence, but some people recommend initiation of gabapentin along with antiviral therapy at sign of outbreak
First line treatment options for postherpetic neuralgia
- Gabapentin/pregabalin
- Lidocaine skin patch
- capsaicin cream
