Simple notes on herpes zoster infection

Herpes Zoster (HZ)
The varicella-zoster virus causes the characteristic herpetic lesion similar to herpes simplex. Whereas varicella represents a primary lesion, herpes zoster (shingles) represents reactivation of the virus from the dorsal root ganglion and results in the classic dermatomic distribution. Herpes zoster is a common condition. There is a correlation between age and incidence of the condition. The disease usually affects the elderly and the immunocompromised patients. Constitutional symptoms are followed by tingling and pain, erythema, and vesicle formation in a dermatomic distribution
Major complications of herpes zoster
1) Acute phase
a) Ocular involvement-Herpes ophthalmitis
b) Secondary infection
c) Cutaneous or visceral dissemination
2) Chronic phase
a) Post-herpetic neuralgia
b) Scarring
c) Motor neuropathy, post-infection encephalomyelitis, paralysis
Treatment
1) Topical agents
a) Acyclovir cream
b) Topical antibiotic cream may be useful in lesions with secondary infection
2) Systemic agents
a) Oral acyclovir 800 mg 5 times daily for 1 week
b) Oral Famciclovir 250 mg 3 times daily for 1 week
c) Oral Valaciclovir 1 gram 3 times daily for 1 week
In immunocompromised patient, IV acyclovir treatment is indicated.
Indications of systemic anti-viral treatment.
a) Patients get skin rashes within 3 days of onset, especially for the elderly group.
b) Patients suffer from ophthalmopathy within 3 days of onset.
c) Immunocompromised patient whenever vesicles present.