Derma Clinic
Herpes Zoster

Herpes zoster, commonly known as shingles (जनै खटिरा / Janai Khatira), is a localized viral infection resulting from the reactivation of the varicella-zoster virus (VZV) the same virus that causes chickenpox . After someone has chickenpox, the virus stays in their body but becomes inactive in the nerve roots . Shingles occurs when this virus becomes active again later in life . It’s important to know that shingles is not the same virus that causes cold sores or genital herpes .  

Herpes Zoster Article in Nepali Language: जनै खटिरा / Janai Khatira

What Happens in the Body?

When the virus reactivates, it starts to multiply in the nerve cells . The new virus particles then travel down the nerve to the skin area connected to that nerve . This causes inflammation and leads to the formation of blisters . This process explains why the shingles rash appears in a specific area on one side of the body, following the path of a nerve .  

Who Gets Herpes Zoster?

The risk of getting shingles increases as people get older, and about half of all cases occur in people over 50 . It’s estimated that 10% to 30% of people who have had chickenpox will get shingles at some point .  

Certain people have a higher risk of developing shingles and experiencing more severe problems . These include:  

  • Older adults, as their immune system naturally weakens with age .  
  • People with weakened immune systems due to conditions like cancer, HIV, or organ transplants .  
  • Individuals taking medications that suppress the immune system, such as steroids .  
  • People experiencing illnesses, stress, or physical injury .  

Recognizing the Symptoms

Herpes Zoster usually develops in stages .

Early Signs (Pre-eruptive Phase): These can appear a few days before the rash and include :  

  • Pain, burning, tingling, or itching in a specific area of the skin .
  • Headache .
  • Feeling unwell (malaise) .  
  • Sensitivity to light (photophobia) .
  • Fever .
  • Chills .
  • Fatigue .
  • Upset stomach .

The Rash (Acute Eruptive Phase): This usually appears within a few days of the initial symptoms .

  • A red rash develops, typically on one side of the body in a band-like pattern . It rarely crosses the midline of the body .
  • The rash quickly turns into small, fluid-filled blisters called vesicles .
  • New blisters can continue to appear for 3 to 5 days .
  • The blisters then dry out and form scabs or crusts .
  • The rash usually heals within 2 to 4 weeks, and the scabs typically fall off in about 10 days .
  • Sometimes, the affected skin may have permanent changes in color or scarring .

The rash most commonly appears on the torso or face . It can wrap around the left or right side of the body . It can also occur on one side of the face, potentially affecting the forehead, scalp, and areas around the eye or ear, or on the neck .

How is Herpes Zoster Diagnosed?

Doctors usually diagnose Herpes Zoster by looking at the characteristic rash and hearing about the patient’s symptoms . The location and appearance of the rash are key clues .

In some cases, especially if the rash is not typical or in the early stages, laboratory tests might be needed . The most common and reliable test is the polymerase chain reaction (PCR) test, which detects the virus’s DNA in samples from the blisters . Other tests like viral culture or direct fluorescent antibody (DFA) assays are less common . Blood tests for antibodies are not usually helpful for diagnosing an active shingles infection .

Possible Complications

Herpes Zoster can sometimes lead to complications .

  • Postherpetic Neuralgia (PHN): This is the most common complication, causing long-lasting nerve pain in the area of the rash, even after it has healed . The risk increases with age .
  • Herpes Zoster Ophthalmicus (HZO): If shingles affects the eye, it can cause serious problems like vision loss .
  • Ramsay Hunt Syndrome: This occurs when shingles affects nerves in the face and ear, leading to facial paralysis, ear pain, hearing loss, and dizziness .
  • Neurological Issues: Rarely, shingles can lead to inflammation of the brain (encephalitis) or spinal cord (myelitis), as well as nerve problems .
  • Bacterial Infections: The shingles blisters can sometimes get infected with bacteria .
  • Other Complications: In rare cases, shingles can cause pneumonia, hearing or balance problems, or even death, especially in people with weakened immune systems . Shingles in the mouth can lead to dental problems .  

How is Herpes Zoster Treated?

The main goal of shingles treatment is to reduce pain, shorten the illness, and prevent complications .

Antiviral Medications: These medicines help to stop the virus from multiplying. They work best when started within 72 hours of the rash appearing . Common antiviral drugs include :

  • Acyclovir
  • Valacyclovir
  • Famciclovir

Valacyclovir and famciclovir are often preferred because the body absorbs them better and they don’t need to be taken as often as acyclovir .

Pain Relief: Pain from herpes zoster can be severe, so pain management is important .

  • Over-the-counter pain relievers: Acetaminophen (Tylenol) or NSAIDs like ibuprofen (Motrin, Advil) or naproxen can help with mild to moderate pain .
  • Prescription pain medications: For more severe pain, doctors might prescribe stronger pain relievers, including opioids like codeine, tramadol, oxycodone, or morphine .
  • Topical treatments: Creams, gels, sprays, or patches containing lidocaine or capsaicin can provide localized pain relief .
  • Corticosteroids: Sometimes, doctors prescribe medications like prednisone along with antivirals to reduce pain and speed up healing, especially in older adults .
  • For postherpetic neuralgia: Medications like tricyclic antidepressants (amitriptyline, nortriptyline, desipramine), anticonvulsants (gabapentin, pregabalin), and long-acting opioids may be used to manage the nerve pain . Nerve blocks or steroid injections might be options for severe pain .

Supportive Care: These measures can help with comfort and healing .

  • Apply cool, wet compresses to the rash .
  • Use calamine lotion to relieve itching .
  • Take warm oatmeal baths for itching .
  • Keep the rash clean and dry to prevent infections .
  • Get enough rest and avoid stress .
  • Eat a healthy diet and exercise regularly .
  • Wear loose-fitting clothing .
  • Avoid touching or scratching the rash to prevent spreading the virus .

Important Note

If you think you might have shingles, it’s important to see a dermatologist as soon as possible, especially if the rash is near your eye or if you have a weakened immune system . Early treatment can help reduce the severity of the illness and prevent complications .

Where to go for Treatment:

Derma Clinic is the Best Clinic for Herpes Zoster treatment in Kathmandu,Nepal.

Contact:
Derma Clinic

Basundhara Chowki
01-5918555 or 9801358600