HERPES ZOSTER

Aetiology

• Herpes zoster is the result of reactivation of varicella zoster virus (VZV) lying dormant in the dorsal root ganglion following chicken pox in early life. This may occur spontaneously or with immunosuppression by other diseases, when it can be severe and widespread (e.g. use of steroids, and HIV infection).

 

Clinical Features

• Symptoms and signs are dermatomal in distribution. The dermatomes from T3 to L3 are most commonly involved although cranial nerves may also be involved.

• First manifestation is pain in the involved dermatome.

• In 3--4 days skin becomes red and vesicles appear. Vesicles dry up in a week's time leaving scars.

• Pain, which is severe and burning in nature, persists as long as vesicles remain.

• Herpes over face usually involves the first division of Vth nerve and occasionally Vllth nerve (Ramsay-Hunt syndrome).

• Some individuals may only present with prodromal symptoms, never developing the telltale rash. This phenomenon is known as "zoster sine herpete."

• Multidermatomal involvement or dissemination is seen in immunocompromised patients.

 

Complications

• When Vth nerve gets involved, cornea is affected. If appropriate care is not taken, it may get damaged permanently.

• Sometimes, pain persists indefinitely even after the vesicles have dried up. When pain persists even after 4-6 weeks, it is called postherpetic neuralgia. The risk for postherpetic neuralgia increases with age, and almost half of patients over 60 years who experience herpes zoster will develop it, immunocompromised patients being more susceptible.

• Other potential complications include encephalitis, myelitis, meningitis and peripheral nerve palsies.

 

Diagnosis

• The diagnosis is mainly clinical.

• The polymerase chain reaction (PCR) technique is the most sensitive and specific diagnostic test, as it can detect VZV DNA in fluid from the vesicle. It can be used if diagnosis is not clear.

 

 

 

TREATMENT AT DR. SOHAN LAL CLINIC

The integrated POLYCLINIC facility offers patients to select their treatment either from the Department of Homeopathy or from the Department of Medicine.

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