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Shingles (Varicella Zoster) (Clinical presentation (Pain (Character …
Shingles
(Varicella Zoster)
Definition
Infectious disease caused by reactivation
of varicella zoster virus from dorsal root ganglion
Pathophysiology
Reactivation causes virus to become active
in the dermatome of the dorsal root ganglion
Varicella zoster virus causes Chickenpox
at primary infection then lays dormant in
dorsal root ganglia
Immune changes facilitate reactivation
Risk factors
Elderly
Immunosuppressed
Clinical
presentation
Pain
Character
Burning/itching?
Radiation
Nil
Onset
Insidious (few days)
Associated symptoms
Erythematous vesicular rash
Fever
Malaise
Site
Dermatome (any)
Timing
Fever
Malaise
Rash
Erythema
Vesicles with crusting
Specific types
Oral (CN V2/V3)
Maxillary or mandibular
Ramsay-Hunt (CN VII)
Facial palsy
Lesions on pinna, side of tongue
and hard palate
Ophthalmic (CN V1)
Skin lesions on nose tip
Can affect eye (can cause iritis)
Diagnosis
Examination
Investigations
History
Management
Initial (ABCDE)
Definitive
Medical
Antivirals e.g. aciclovir, famciclovir
Analgesia (WHO ladder)
Abx (if secondary infevction)
Referral
To ophthalmology if ophthalmic shingles
(need antiviral ointment and regular acuity tests)
Complications
Post-herpetic neuralgia
Amitriptyline, gabapentin
Topical lidocaine patch
Ganglion ablation
Prevention
HZ vaccine
Patients >60y