Activation of the dormant varicella-zoster virus (VZV) is responsible for an outbreak of shingles. The incidence of herpes zoster (shingles) is increased with older age. It is important to remember that this condition is a disease of immunosuppression.
Shingles presents as a unilateral rash that has a linear distribution. The rash is characterized as a vesicular, erythematous maculopapular rash. Linear distribution of the shingles rash typically occurs along a single dermatome plane on the patient’s trunk, face, and/or lower back/sacral area.
Patients may report pruritus, or itching, during the shingles outbreak. When extreme pruritus occurs after the infection has resolved, it is referred to as postherpetic itch. This condition can be treated with a topical anesthetic.
Postherpetic neuralgia is a chronic pain disorder that can develop after an acute infection with herpes zoster (shingles). Burning pain is commonly associated with this type of neuralgia. In an effort to prevent the development of postherpetic neuralgia, patients may be given antiviral medications.
Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can be administered within 72 hours to prevent the development of postherpetic neuralgia.
Analgesics can be administered to decrease a patient’s discomfort. Wet compresses may provide additional relief from pain and itching.
Patients who develop postherpetic neuralgia after a shingles outbreak may be treated with gabapentin (Neurontin). Although this medication is an anticonvulsant, it is effective in treating neuropathic pain associated with shingles.
The rash present during an outbreak of shingles is contagious. Individuals who have not had varicella (chickenpox) or who have not been vaccinated against the disease along with those who are immunosuppressed are at an increased risk of contracting the virus.
The preferred method of zoster prevention is a killed recombinant vaccine sold under the name Shingrix. There is also a live vaccine available sold as Zostavax.
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