Viral Infections : HERPES ZOSTER (SHINGLES)

Question 1

HERPES ZOSTER (SHINGLES) Clinical Feature prodrome, area

Answer 1

unilateral dermatomal eruption occurring 3-5 d after pain and paresthesia of that dermatome
•typically involves a single
dermatome; lesions rarely cross the midline

Question 2

HERPES ZOSTER (SHINGLES) lesion

Answer 2

vesicles, bullae, and pustules on an erythematous, edematous base

lesions may become eroded/ulcerated and last days to weeks

Question 3

HERPES ZOSTER (SHINGLES)
pain

Answer 3

pain can be pre-herpetic, synchronous with rash, or post-herpetic

Question 4

HERPES ZOSTER (SHINGLES)
consecuences

Answer 4

severe post-herpetic neuralgia often occurs in elderly

Question 5

HERPES ZOSTER (SHINGLES)
Hutchinson’s sign

Answer 5

shingles on the tip of the nose signifies ocular involvement.
shingles in this area involves the nasociliary branch of the ophthalmic branch of the trigeminal
nerve (V1)

Question 6

HERPES ZOSTER (SHINGLES) distribution:

Answer 6

thoracic (50%), trigeminal (10-20%), cervical (10-20%); disseminated in HIV

Question 7

HERPES ZOSTER (SHINGLES)
Etiology

Answer 7

caused by reactivation of VZV

Question 8

HERPES ZOSTER (SHINGLES) risk factors

Answer 8

immunosuppression, old age, occasionally associated with hematologic malignancy

Question 9

HERPES ZOSTER (SHINGLES) Investigations

Answer 9

none required, but can do Tzanck test, direct fluorescence antibody test, or viral culture to rule out HSV

Question 10

HERPES ZOSTER (SHINGLES) Prevention

Answer 10

routine vaccination in 50+ yr old with Shingrix® (recombinant zoster vaccine) preferred to in 60+ yr old
with Zostavax® (live zoster vaccine

Question 11

HERPES ZOSTER (SHINGLES) Management topical

Answer 11

compress with normal saline, Burow’s or betadine solution

Question 12

HERPES ZOSTER (SHINGLES) Management
oral antivirals:

Answer 12

famciclovir, valacyclovir, or acyclovir for 7 d; must initiate within 72 h to be of benefitt

Question 13

HERPES ZOSTER (SHINGLES) Management analgesia:

Answer 13

NSAIDs, acetaminophen for mild-moderate pain; opioids if severe

Question 14

HERPES ZOSTER (SHINGLES) Management post-herpetic neuralgia

Answer 14

TCAs, anticonvulsants (gabapentin, pregabalin)