Shingles Flashcards
What are 5 symptoms of shingles?
- Tender and painful skin signals the beginning of the attack
- Skin rash (red)
- Rash has a characteristic pattern (belt or band)
- Rash typically affects chest and stomach
- Tiny fluid filled blisters
Does shingles require a counselling room?
No
What are 10 red flags for referral with shingles?
- Refer all patients if presenting within 72 hours of symptom onset for antiviral treatment.
- Ocular involvement or general forehead region
- Numbness
- Vomiting and fever
- Secondary bacterial skin infection
- Post-herpetic neuralgia (pain after rash/shingles has resolved)
- Pregnant patient
- Children
- Dermatomal pain but no rash (zoster siné herpéte)
- Disseminated herpes zoster: widespread vesicular rash, and visceral, central nervous system and pulmonary involvement
Does shingles have a PSA self-care card?
Yes (Shingles)
What is the preferred over-the-counter treatment option for shingles?
Simple analgesics (paracetamol, ibuprofen).
What is the standard dosage of paracetamol?
15 mg/kg (up to 1,000 mg) every FOUR to SIX hours. Maximum of 60 mg/kg (up to 4,000 mg) in 24 hours.
What is the standard dosage of ibuprofen?
5 to 10 mg/kg (maximum 400 mg) every 4 to.6 hours. Maximum of 30 mg/kg (up to 1200 mg) in 24 hours.
What are 2 non-preferred over-the-counter options for shingles and why?
- Capsaicin: cannot be applied to active lesions and may be irritating
- Calamine lotion: dries out skin
Is paracetamol safe in pregnancy?
Yes
Is paracetamol safe in breastfeeding?
Yes
What is the age range for paracetamol?
Safe in children over 1 month
Is ibuprofen safe in pregnancy?
No
Is ibuprofen safe in breastfeeding?
Yes
What is the age range for ibuprofen?
Safe in children over 3 months
What are 10 pieces of non-pharmacological advice for shingles?
- Rest
- Increase fluids
- Keep the area nice and clean to prevent secondary infection
- Wear loose fitting clothing’s for extra comfort
- Avoid contact with others.
- Virus can spread through direct contact with the blisters or through dressing, clothes, or sheets that have been soiled with discharge
- Topical capsaicin cream or lignocaine gel/patch once rash has healed
- Ice packs, cool wet compresses
- Don’t scratch (cut nails short to reduce the risk of bacterial infection from scratch)
- General hygiene to prevent spread and bacterial infection
What is shingles caused by?
A reactivation of varicella zoster virus (VZV, chickenpox), usually several decades later
Describe the duration of a shingles episode.
Acute and self-limiting infection
Describe the incidence of shingles.
Shingles is uncommon in childhood, incidence increases with age or immune deficiency. It is Common in elderly population
How is shingles transmitted?
Direct contact with shingles blister fluid can cause chickenpox in a non-immune person. Contact with chickenpox or shingles cannot lead to shingles in exposed person since shingles can only follow the reactivation of a previous chickenpox infection
What is the Infectious period of shingles?
From the appearance of the rash until all blisters have dried up
What is the lifetime risk of reactivation of varicella-zoster virus?
Approximately 50%
What is the main risk factor for severe shingles infection?
Immunocompromised people with previous chickenpox infection
How long prior to a shingles infection may Prodromal symptoms occur?
They can occur for several days before the rash appears.
Describe the prodromal symptoms of shingles.
A tingling, burning sensation in the affected area (where rash will appear), potentially with associated itching, severe pain, Headache, Tiredness, general malaise and photophobia.
How does the shingles rash typically present?
As a unilateral band-like cluster of blisters on a base of red skin.
When is pain from shingles considered to be post-herpetic neuralgia?
If the pain lasts for over 3 months it is typically considered to be post-herpetic neuralgia
Describe the healing process with shingles.
Blisters erupt over a week and then heal over 2 weeks
