Shingles

Question 1

What is shingles?

Answer 1

• temporary, self limiting rash from herpes zoster aka varicella zoster (HHV-3)
• reactivation following primary chicken pox infection in childhood
• virus is dormant in dorsal root ganglion (or trigeminal ganglion or geniculate facial nerve ganglion)
• dermatonal pattern
• age, immunosuppression and stress
• ophthalmic shingles!
• Ramsay-Hunt syndrome (facial nerve, ear skin: hearing, vestibular and facial paralysis)
• aciclovir within 72 hours
• antiviral to anyone ophthalmic

Question 2

Epidemiology of shingles?

Answer 2

• not much vaccination done so 90% of population at risk
• 8 per 1000 aged 70-79yrs
• fluid of pustules can transmit a primary chickenpox infection to unexposed
• not possible to “catch” shingles

Question 3

Presenation of shingles?

Answer 3

• dermatomal distribution
• never crosses the midline
• pain may be first symptom
• parathesia: pins and needles / tingling
• vesicular “herpetic” rash, clusters
• appear 1-3 days after onset of pain
• lasts 2-3 weeks in younger patients
• longer in elderly
• post-herpetic neuralgia is common for several months

Question 4

Differential diagnosis when considering shingles?

Investigations?

Answer 4

• eczema herpeticum
• impetigo
• dermatitis herpetiformis (from coeliacs disease typically on shins)
• Bell’s Palsy could be confused with Ramsay-Hunt

INVESTIGATIONS:

• usually clinical Dx
• viral PCR
• U&Es for renal function before anti-viral if dose reduction required in renal failire

Question 5

Mangement of shingles?

Answer 5

• keep clean and dry
• keep covered (transmission is low so can continue work /school)
• topical therapies not recommended
• oral antiviral
• VALACICLOVIR 100mg TDS for 7 dyas of ACICLOVIR 800mg 5xday for 7 days
• start within 72 hours of rash
• seek advice if pregnant (may need to give zoster immunoglobulin VF)