Herpes zoster, also known as shingles, is a viral infection caused by the varicella-zoster virus. After a person has chickenpox, the virus remains dormant (inactive) in the body. However, in some people, the virus can reactivate later in life and cause herpes zoster. Herpes zoster typically causes a painful rash with blisters on one side of the body, usually on the face, chest, or back.
The rash typically lasts for about 2-4 weeks, and the blisters will eventually crust over and heal. Shingles are believed to reoccur when the immune system fails to control the virus’s latent replication, leading to the infection’s reactivation. The incidence of shingles is strongly correlated with immune status, with people with strong immune systems being less likely to develop shingles.
Epidemiology
It is estimated that herpes zoster affects about 1 in 3 people in the United States at some point in their lifetime. The incidence of shingles tends to increase with age, with the highest rates occurring in people over 50. However, shingles can occur at any age, including young children and teenagers.
The prevalence of shingles varies worldwide, with higher rates in developed countries and lower rates in developing countries. It is estimated that the annual incidence of shingles ranges from 2 to 5 cases per 1,000 people in the United States and Europe and from 0.1 to 1 case per 1,000 people in developing countries.
The mortality rate for shingles is generally low, with most people recovering fully. However, shingles can lead to severe complications in some cases, such as vision loss or nerve damage. These complications are common in older adults and people with compromised immune conditions.
Anatomy
Pathophysiology
The pathophysiology of herpes zoster involves the reactivation of the varicella-zoster virus. After a person has chickenpox, the virus remains dormant (inactive) in the body and can reactivate later in life to cause shingles. The varicella-zoster virus is primarily transmitted through contact with the fluid from chickenpox blisters or through respiratory secretions, such as saliva or mucus.
After a person is exposed to the virus, it typically takes about 2 to 3 weeks for chickenpox to develop. Once the virus enters the body, it travels through the bloodstream to the skin, where it multiplies and causes a rash. The rash consists of small, fluid-filled blisters that eventually crust over and heal. In some cases, the virus can also affect mucous membranes and internal organs.
The immune system plays a key role in the development and resolution of shingles. The virus can clear the infection within a few weeks in individuals with healthy immune systems. However, in people with compromised immune systems, such as HIV/AIDS, cancer, or certain medications that suppress the immune system, the virus may be more challenging to control, leading to a more severe and prolonged infection.
Etiology
After a person has chickenpox, the virus remains dormant (inactive) in the body and can reactivate later in life to cause shingles. The main risk factor for developing herpes zoster is the previous infection with the varicella-zoster virus, either through chickenpox or through the administration of the chickenpox vaccine. Other risk factors for developing shingles include:
Age: The incidence of shingles increases with age, with the highest rates occurring in people over 50.
Weakened immune system: People with weakened immune systems, such as those with HIV/AIDS, cancer, or those taking certain medications that suppress the immune system, are at increased risk of developing shingles.
Comorbidities: People with chronic medical conditions, such as diabetes or heart disease, may be at increased risk of developing shingles.
Stress: Stressful situations or events may increase the risk of developing shingles.
Exposure to the varicella-zoster virus: People who have close contact with someone with shingles or chickenpox may be at increased risk of developing shingles.
Genetics
Prognostic Factors
The prognosis for herpes zoster is generally good, with most people recovering fully. However, the severity of the infection and the associated symptoms can vary widely, and some people may experience more severe complications. In most cases, the rash and blisters associated with shingles will resolve within 2-4 weeks, and the pain will gradually improve.
However, some people may experience ongoing pain after the rash has healed. This condition is known as post-herpetic neuralgia, and it can be challenging to manage and may significantly impact a person’s quality of life.
In rare cases, shingles can lead to severe complications, such as vision loss or nerve damage. These complications are common in older adults and people with weakened immune systems. There is also a vaccine available to help prevent shingles in people over the age of 50.
Clinical History
Clinical History
Herpes zoster is a viral infection characterized by a prodrome of symptoms such as fever, malaise, and severe burning pain. This is followed by developing vesicular eruptions in a specific pattern, usually on one side of the body within a single dermatome. The lesions begin as small, red papules that quickly turn into vesicles on an inflamed and swollen base.
They may appear in a continuous or interrupted band, potentially involving multiple contiguous dermatomes. The most affected areas include the thoracic, cervical, and trigeminal regions, including the ophthalmic and lumbosacral areas. Herpes zoster can affect the mouth if the trigeminal nerve maxillary or mandibular division is affected.
It is clinically characterized by the presence of vesicles or erosions on the mucous membrane of the upper or lower jaw. These oral symptoms can occur alone or in conjunction with skin lesions in the same trigeminal nerve area. Additionally, due to the proximity of blood vessels to nerves, the virus can spread to affect blood vessels and compromise blood supply, leading to ischemic necrosis.
Physical Examination
Physical Examination
The classic findings of the condition include clusters of painful blisters on a red, irritated skin surface, which is only located on one side of the body and is limited to a specific nerve area, known as a dermatome, most often in the thoracic area. Swelling in nearby lymph nodes may also occur. After an initial infection, red spots and bumps appear and develop into blisters within a day.
These blisters eventually become cloudy, burst, form scabs, and heal. Patients may experience pain and loss of sensation in the rash area. Weakness in the muscles, particularly in the lower back and neck, is often present but not recognized, and is a sign of the virus affecting areas beyond the sensory nerves. Due to the difficulty in accurately diagnosing this weakness, it is uncertain how often it occurs.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Chickenpox
Cellulitis
Contact stomatitis
Ecthyma
Folliculitis
Irritant contact dermatitis
Lichen striatus
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Antiviral medications help reduce the severity and duration of the shingles infection, such as acyclovir, valacyclovir, and famciclovir. Corticosteroids such as prednisone and methylprednisolone are commonly used. Topical antibiotic creams, such as mupirocin or soframycin, can be applied to the skin to help prevent secondary bacterial infections in cases of herpes zoster or shingles. Analgesics, or pain relievers, can also be used to help manage the pain associated with shingles.
In some cases, severe pain may require the use of opioid medications. Additionally, the use of topical lidocaine or nerve blocks may help to reduce pain. These treatments can be used in combination with antiviral medications to help manage the symptoms of shingles and prevent complications. Post-herpetic neuralgia is a condition that can occur after a herpes zoster, or shingles, infection. It is characterized by ongoing pain that persists even after the rash has healed.
This condition is more common in elderly patients and can be difficult to manage. Once the lesions associated with shingles have crusted over, treatment options may include the use of topical capsaicin and Emla. Capsaicin cream is a topical medication that can help reduce pain by depleting a chemical called substance P, which is involved in pain transmission. Emla cream is a topical anesthetic that can help numb the skin and reduce pain.
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References
https://www.ncbi.nlm.nih.gov/books/NBK441824/
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Herpes zoster, also known as shingles, is a viral infection caused by the varicella-zoster virus. After a person has chickenpox, the virus remains dormant (inactive) in the body. However, in some people, the virus can reactivate later in life and cause herpes zoster. Herpes zoster typically causes a painful rash with blisters on one side of the body, usually on the face, chest, or back.
The rash typically lasts for about 2-4 weeks, and the blisters will eventually crust over and heal. Shingles are believed to reoccur when the immune system fails to control the virus’s latent replication, leading to the infection’s reactivation. The incidence of shingles is strongly correlated with immune status, with people with strong immune systems being less likely to develop shingles.
It is estimated that herpes zoster affects about 1 in 3 people in the United States at some point in their lifetime. The incidence of shingles tends to increase with age, with the highest rates occurring in people over 50. However, shingles can occur at any age, including young children and teenagers.
The prevalence of shingles varies worldwide, with higher rates in developed countries and lower rates in developing countries. It is estimated that the annual incidence of shingles ranges from 2 to 5 cases per 1,000 people in the United States and Europe and from 0.1 to 1 case per 1,000 people in developing countries.
The mortality rate for shingles is generally low, with most people recovering fully. However, shingles can lead to severe complications in some cases, such as vision loss or nerve damage. These complications are common in older adults and people with compromised immune conditions.
The pathophysiology of herpes zoster involves the reactivation of the varicella-zoster virus. After a person has chickenpox, the virus remains dormant (inactive) in the body and can reactivate later in life to cause shingles. The varicella-zoster virus is primarily transmitted through contact with the fluid from chickenpox blisters or through respiratory secretions, such as saliva or mucus.
After a person is exposed to the virus, it typically takes about 2 to 3 weeks for chickenpox to develop. Once the virus enters the body, it travels through the bloodstream to the skin, where it multiplies and causes a rash. The rash consists of small, fluid-filled blisters that eventually crust over and heal. In some cases, the virus can also affect mucous membranes and internal organs.
The immune system plays a key role in the development and resolution of shingles. The virus can clear the infection within a few weeks in individuals with healthy immune systems. However, in people with compromised immune systems, such as HIV/AIDS, cancer, or certain medications that suppress the immune system, the virus may be more challenging to control, leading to a more severe and prolonged infection.
After a person has chickenpox, the virus remains dormant (inactive) in the body and can reactivate later in life to cause shingles. The main risk factor for developing herpes zoster is the previous infection with the varicella-zoster virus, either through chickenpox or through the administration of the chickenpox vaccine. Other risk factors for developing shingles include:
Age: The incidence of shingles increases with age, with the highest rates occurring in people over 50.
Weakened immune system: People with weakened immune systems, such as those with HIV/AIDS, cancer, or those taking certain medications that suppress the immune system, are at increased risk of developing shingles.
Comorbidities: People with chronic medical conditions, such as diabetes or heart disease, may be at increased risk of developing shingles.
Stress: Stressful situations or events may increase the risk of developing shingles.
Exposure to the varicella-zoster virus: People who have close contact with someone with shingles or chickenpox may be at increased risk of developing shingles.
The prognosis for herpes zoster is generally good, with most people recovering fully. However, the severity of the infection and the associated symptoms can vary widely, and some people may experience more severe complications. In most cases, the rash and blisters associated with shingles will resolve within 2-4 weeks, and the pain will gradually improve.
However, some people may experience ongoing pain after the rash has healed. This condition is known as post-herpetic neuralgia, and it can be challenging to manage and may significantly impact a person’s quality of life.
In rare cases, shingles can lead to severe complications, such as vision loss or nerve damage. These complications are common in older adults and people with weakened immune systems. There is also a vaccine available to help prevent shingles in people over the age of 50.
Clinical History
Herpes zoster is a viral infection characterized by a prodrome of symptoms such as fever, malaise, and severe burning pain. This is followed by developing vesicular eruptions in a specific pattern, usually on one side of the body within a single dermatome. The lesions begin as small, red papules that quickly turn into vesicles on an inflamed and swollen base.
They may appear in a continuous or interrupted band, potentially involving multiple contiguous dermatomes. The most affected areas include the thoracic, cervical, and trigeminal regions, including the ophthalmic and lumbosacral areas. Herpes zoster can affect the mouth if the trigeminal nerve maxillary or mandibular division is affected.
It is clinically characterized by the presence of vesicles or erosions on the mucous membrane of the upper or lower jaw. These oral symptoms can occur alone or in conjunction with skin lesions in the same trigeminal nerve area. Additionally, due to the proximity of blood vessels to nerves, the virus can spread to affect blood vessels and compromise blood supply, leading to ischemic necrosis.
Physical Examination
The classic findings of the condition include clusters of painful blisters on a red, irritated skin surface, which is only located on one side of the body and is limited to a specific nerve area, known as a dermatome, most often in the thoracic area. Swelling in nearby lymph nodes may also occur. After an initial infection, red spots and bumps appear and develop into blisters within a day.
These blisters eventually become cloudy, burst, form scabs, and heal. Patients may experience pain and loss of sensation in the rash area. Weakness in the muscles, particularly in the lower back and neck, is often present but not recognized, and is a sign of the virus affecting areas beyond the sensory nerves. Due to the difficulty in accurately diagnosing this weakness, it is uncertain how often it occurs.
Differential Diagnoses
Chickenpox
Cellulitis
Contact stomatitis
Ecthyma
Folliculitis
Irritant contact dermatitis
Lichen striatus
Antiviral medications help reduce the severity and duration of the shingles infection, such as acyclovir, valacyclovir, and famciclovir. Corticosteroids such as prednisone and methylprednisolone are commonly used. Topical antibiotic creams, such as mupirocin or soframycin, can be applied to the skin to help prevent secondary bacterial infections in cases of herpes zoster or shingles. Analgesics, or pain relievers, can also be used to help manage the pain associated with shingles.
In some cases, severe pain may require the use of opioid medications. Additionally, the use of topical lidocaine or nerve blocks may help to reduce pain. These treatments can be used in combination with antiviral medications to help manage the symptoms of shingles and prevent complications. Post-herpetic neuralgia is a condition that can occur after a herpes zoster, or shingles, infection. It is characterized by ongoing pain that persists even after the rash has healed.
This condition is more common in elderly patients and can be difficult to manage. Once the lesions associated with shingles have crusted over, treatment options may include the use of topical capsaicin and Emla. Capsaicin cream is a topical medication that can help reduce pain by depleting a chemical called substance P, which is involved in pain transmission. Emla cream is a topical anesthetic that can help numb the skin and reduce pain.
https://www.ncbi.nlm.nih.gov/books/NBK441824/
medtigo
Herpes zoster
Updated :
August 30, 2023
Herpes zoster, also known as shingles, is a viral infection caused by the varicella-zoster virus. After a person has chickenpox, the virus remains dormant (inactive) in the body. However, in some people, the virus can reactivate later in life and cause herpes zoster. Herpes zoster typically causes a painful rash with blisters on one side of the body, usually on the face, chest, or back.
The rash typically lasts for about 2-4 weeks, and the blisters will eventually crust over and heal. Shingles are believed to reoccur when the immune system fails to control the virus’s latent replication, leading to the infection’s reactivation. The incidence of shingles is strongly correlated with immune status, with people with strong immune systems being less likely to develop shingles.
It is estimated that herpes zoster affects about 1 in 3 people in the United States at some point in their lifetime. The incidence of shingles tends to increase with age, with the highest rates occurring in people over 50. However, shingles can occur at any age, including young children and teenagers.
The prevalence of shingles varies worldwide, with higher rates in developed countries and lower rates in developing countries. It is estimated that the annual incidence of shingles ranges from 2 to 5 cases per 1,000 people in the United States and Europe and from 0.1 to 1 case per 1,000 people in developing countries.
The mortality rate for shingles is generally low, with most people recovering fully. However, shingles can lead to severe complications in some cases, such as vision loss or nerve damage. These complications are common in older adults and people with compromised immune conditions.
The pathophysiology of herpes zoster involves the reactivation of the varicella-zoster virus. After a person has chickenpox, the virus remains dormant (inactive) in the body and can reactivate later in life to cause shingles. The varicella-zoster virus is primarily transmitted through contact with the fluid from chickenpox blisters or through respiratory secretions, such as saliva or mucus.
After a person is exposed to the virus, it typically takes about 2 to 3 weeks for chickenpox to develop. Once the virus enters the body, it travels through the bloodstream to the skin, where it multiplies and causes a rash. The rash consists of small, fluid-filled blisters that eventually crust over and heal. In some cases, the virus can also affect mucous membranes and internal organs.
The immune system plays a key role in the development and resolution of shingles. The virus can clear the infection within a few weeks in individuals with healthy immune systems. However, in people with compromised immune systems, such as HIV/AIDS, cancer, or certain medications that suppress the immune system, the virus may be more challenging to control, leading to a more severe and prolonged infection.
After a person has chickenpox, the virus remains dormant (inactive) in the body and can reactivate later in life to cause shingles. The main risk factor for developing herpes zoster is the previous infection with the varicella-zoster virus, either through chickenpox or through the administration of the chickenpox vaccine. Other risk factors for developing shingles include:
Age: The incidence of shingles increases with age, with the highest rates occurring in people over 50.
Weakened immune system: People with weakened immune systems, such as those with HIV/AIDS, cancer, or those taking certain medications that suppress the immune system, are at increased risk of developing shingles.
Comorbidities: People with chronic medical conditions, such as diabetes or heart disease, may be at increased risk of developing shingles.
Stress: Stressful situations or events may increase the risk of developing shingles.
Exposure to the varicella-zoster virus: People who have close contact with someone with shingles or chickenpox may be at increased risk of developing shingles.
The prognosis for herpes zoster is generally good, with most people recovering fully. However, the severity of the infection and the associated symptoms can vary widely, and some people may experience more severe complications. In most cases, the rash and blisters associated with shingles will resolve within 2-4 weeks, and the pain will gradually improve.
However, some people may experience ongoing pain after the rash has healed. This condition is known as post-herpetic neuralgia, and it can be challenging to manage and may significantly impact a person’s quality of life.
In rare cases, shingles can lead to severe complications, such as vision loss or nerve damage. These complications are common in older adults and people with weakened immune systems. There is also a vaccine available to help prevent shingles in people over the age of 50.
Clinical History
Herpes zoster is a viral infection characterized by a prodrome of symptoms such as fever, malaise, and severe burning pain. This is followed by developing vesicular eruptions in a specific pattern, usually on one side of the body within a single dermatome. The lesions begin as small, red papules that quickly turn into vesicles on an inflamed and swollen base.
They may appear in a continuous or interrupted band, potentially involving multiple contiguous dermatomes. The most affected areas include the thoracic, cervical, and trigeminal regions, including the ophthalmic and lumbosacral areas. Herpes zoster can affect the mouth if the trigeminal nerve maxillary or mandibular division is affected.
It is clinically characterized by the presence of vesicles or erosions on the mucous membrane of the upper or lower jaw. These oral symptoms can occur alone or in conjunction with skin lesions in the same trigeminal nerve area. Additionally, due to the proximity of blood vessels to nerves, the virus can spread to affect blood vessels and compromise blood supply, leading to ischemic necrosis.
Physical Examination
The classic findings of the condition include clusters of painful blisters on a red, irritated skin surface, which is only located on one side of the body and is limited to a specific nerve area, known as a dermatome, most often in the thoracic area. Swelling in nearby lymph nodes may also occur. After an initial infection, red spots and bumps appear and develop into blisters within a day.
These blisters eventually become cloudy, burst, form scabs, and heal. Patients may experience pain and loss of sensation in the rash area. Weakness in the muscles, particularly in the lower back and neck, is often present but not recognized, and is a sign of the virus affecting areas beyond the sensory nerves. Due to the difficulty in accurately diagnosing this weakness, it is uncertain how often it occurs.
Differential Diagnoses
Chickenpox
Cellulitis
Contact stomatitis
Ecthyma
Folliculitis
Irritant contact dermatitis
Lichen striatus
Antiviral medications help reduce the severity and duration of the shingles infection, such as acyclovir, valacyclovir, and famciclovir. Corticosteroids such as prednisone and methylprednisolone are commonly used. Topical antibiotic creams, such as mupirocin or soframycin, can be applied to the skin to help prevent secondary bacterial infections in cases of herpes zoster or shingles. Analgesics, or pain relievers, can also be used to help manage the pain associated with shingles.
In some cases, severe pain may require the use of opioid medications. Additionally, the use of topical lidocaine or nerve blocks may help to reduce pain. These treatments can be used in combination with antiviral medications to help manage the symptoms of shingles and prevent complications. Post-herpetic neuralgia is a condition that can occur after a herpes zoster, or shingles, infection. It is characterized by ongoing pain that persists even after the rash has healed.
This condition is more common in elderly patients and can be difficult to manage. Once the lesions associated with shingles have crusted over, treatment options may include the use of topical capsaicin and Emla. Capsaicin cream is a topical medication that can help reduce pain by depleting a chemical called substance P, which is involved in pain transmission. Emla cream is a topical anesthetic that can help numb the skin and reduce pain.
https://www.ncbi.nlm.nih.gov/books/NBK441824/
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