Herpes Zoster

Herpes zoster is caused by Varicella virus, the virus that causes chickenpox in children and shingles in older adults.

Normally, this virus first enters the body in childhood to cause chickenpox. The virus then lies dormant in the spinal ganglia for many years and can become active during a time of reduced resistance to cause shingles, a unilateral patch of skin blisters and discoloration along the path of one or more spinal nerves, most commonly around the waist. The symptoms may persist for 3 to 6 months.

The first symptom of zoster is burning pain or tingling on skin usually limited to one side of the body. This may be present for couple of days before a red or pinkish rash appears at that site. There may also be fever or headache. The rash soon turns into groups of blisters. The blisters generally last for two to three weeks. The blisters start out clear but then pus or dark blood collects in the blisters before they crust over and begin to disappear. The pain may last longer.

Treatment

Herpes zoster, usually clears on its own in a few weeks. Pain relievers and cool compresses are helpful in drying the blisters.

Herpes zoster usually resolves spontaneously, and may not require treatment except for symptomatic relief such as pain medication.

If diagnosed early, oral antiviral drugs can be prescribed to decrease the duration of skin lesions. They are routinely prescribed for severe cases of zoster e.g. for those with decreased immunity.

Acyclovir

Acyclovir is an antiviral medication that may be prescribed to shorten the course, reduce pain, reduce complications or protect an immunocompromised individual. Desciclovir, famciclovir, valaciclovir, and penciclovir are similar to acyclovir and may be used to treat zoster. For the greatest effect, acyclovir-like medications should be started within 24 hours of the appearance of pain or burning sensation and preferably before the appearance of the characteristic blisters. Severely immunocompromised individuals may require intravenous acyclovir therapy.

Corticosteroids

Corticosteroids such as prednisone may occasionally be used to reduce inflammation and risk of post-herpetic neuralgia (severe pain related to nerves). They have been shown to be most effective in the elderly population. Corticosteroids have certain risks that should be considered before using them.

Analgesics

Analgesics, mild to strong, may be needed to control pain. Antihistamines may be used topically (direct application to the body) or orally to reduce itching.

Zostrix

Zostrix, a cream containing capsaicin (an extract of pepper), can be used to possibly prevent post-herpetic neuralgia. The ointment is applied to painful areas of the skin three to four times a day and the pain gradually eases over one to three weeks.

Supportive Measures

Over-the-counter pain medications like motrin or aleve may help the pain to some extent. These medications should be taken only after meals. They should be avoided if there is a history of allergy, gastritis, heartburn or peptic ulcer. If the pain is severe, motrin or aleve may not relieve it completely, and then opioids like oxycodone or morphine need to be prescribed.

Cool wet compresses may reduce pain. Soothing baths and lotions such as colloidal oatmeal bath, starch baths or lotions, and calamine lotion may help to relieve itching and discomfort. Rest in bed until fever resolves.

Keep the skin clean, and do not re-use contaminated items. Non-disposable items should be washed in boiling water or otherwise disinfected before re-use. The patient may need to be isolated while lesions are oozing to prevent infecting others.

Note that Herpes Zoster is different from more common Herpes Simplex, which is an entirely different disease (and typically affects lips and genitalia).