Herpes zoster

Question 1

reactivation of HSV. Synonym: shingles

Answer 1

Herpes zoster

Question 2

characterized by:

Answer 2

unilateral dysesthesia. Avesicular or bullous eruption limited to a dermatome(s)
innervated by a corresponding sensory ganglion.
■ Postherpetic neuralgia is a major morbidity.

Question 3

centripetal or centrifugal?

Answer 3

fugal

Question 4

manif

Answer 4

PRODROME Pain, tenderness, and paresthesia in the involved dermatome (Fig. 27-50) precedes the eruption. Pain can mimic angina or acute abdomen. Allodynia: Heightened sensitivity to mild stimuli. Zoster sine herpete: Nerve involve- ment can occur without cutaneous zoster. Flu- like constitutional symptoms can occur during prodrome and active in ection. DERMATOMALLESIONS Papules(24hours)→ vesicles-bullae (48 hours) → pustules (96 hours)→crusts(7to10days).Newlesions continue to appear or up to 1 week. Ery- thematous, edematous base (Fig. 27-51) with superimposed clear vesicles, sometimes hemor- rhagic. Vesicles erode orming crusted erosions

Question 5

prediliction

Answer 5

Site of Predilection.Toracic(>50%)(Fig.27-51), trigeminal (10 to 20%) (Fig. 27-52A), lumbosa- cral, and cervical (10 to 20%) (Fig. 27-53)

Question 6

Dx

Answer 6

immunocompromised with unilateral pain. ACTIVEVESICULATION Clinical ndings usually adequate; may be con rmed by zanck test, DFA, or viral culture to rule out HSV in ection. POSTHERPETICPAIN SYNDROME By history and clinical ndings

Question 7

tx

Answer 7

PREVENTION Vaccination against VZV with a live attenuated vaccine reduces the burden o illnessby>60%andincidenceo zoster
by 51%.
ANTIVIRALTHERAPY Oral amciclovir 500 mg every8h or7days;valaciclovir1gevery8h
or 7 days; or acyclovir 800 mg 5 times a day
or 7 days.
Mildly immunocompromised: As said previ- ously, orupto10days.Severelyimmunocom- promised:Acyclovir10mg/kgIVevery8h or 7 to 10 days.
Acyclovirresistant:IV oscarnet40mg/kgIV every 8h until resolution.
SUPPORTIVETHERAPY Bed rest, sedation, pain management with narcotic analgesics; moist dressings.
POSTHERPETICNEURALGIA Gabapentin,prega- balin, tricyclic antidepressants, i.e., doxepin, capsaicin cream topically. Nerve block