HERPES ZOSTER

DEFINITION

•Herpes Zoster or shingles is an acute inflammatory viral disease

Etiology •The causative organism is Varicella-Zoster virus (human herpesvirus 3)

CLINICAL FEATURES

•The thoracic, cervical, trigeminal, and lumbosacral dermatomes are the most frequently affected.

•Oral Lesions occur if the second and third branches of the trigeminal nerve are involved.

ORAL LESIONS

• Itching sensation and pain, which may simulate pulpitis.• Ulcers heal in 2-3 weeks• Unilateral cluster of vesicles which rupture in 2-3

days, leaving painful ulcers surrounded by a red zone• Post-herpetic trigeminal neuralgia and

osteomyelitis of the jaw bone are the most common complication

SKIN LESIONS

• Intense pain associated with pruritus, tingling, and tenderness• Painful eruption of vesicles or erythematous

bases which develop along a sensory dermatome• Rash typically involves a single dermatome and

does not cross the midline but may involve multiple dermatomes• Postherpenic neuralgia in 10-15% of cases

COSTITUTIONAL SYMPTOMS

•Fever•Malaise•Headache

DIAGNOSIS

•The diagnosis is usually made clinically but may be aided by culture. Direct fluorescent antibody test, serology, PCR.

DIFFERENTIAL DIAGNOSIS

• Herpetic gingivostomatitis• Necrotizing Ulcerative Gingivitis• Varicella• Erythema multiforme

TREATMENT

•Patients should be isolated and stay on the bed for 1 week•The diagnosis should be made and treatment begun as early as possible• Immunocompromised patients must be hospitalized.

SUGGESTED THERAPIES

• Antivirals : Valacyclovir 1 g three times dailty for 7 days and famciclovir 500 mg three times daily for 7 days are the drugs of the choice

bcause of the more convenient does regimens than acyclovir

Traditionally, oral acyclovir 800mg 5times daily for 7 – 1 day has been used in treatment of herpes zoster. High-dose acyclovir (30mg/kg per day) for at least 7 days is recommended for the treatment of herpes zoster for immunocompromised patients

• Analgesics, transquilizers, tricyclic anti-depressant, anti-epileptics (carbamazepine, gabapentin) has been used as a pain relief

•Corticosteroids : Early used of prednisone 20 -30 mg/ day for 7 - 10 days tapered to 10 mg/day

for 1 week has been used to reduce incidence of postherpetic neuralgia in elder patients. Corticosteroids must be avoided in immunocompromised patients

VERICELLA

HERPES ZOSTER