Care of Patient with Herpes Zoster

【Major points】

Herpes zoster is an infectious disease caused by varicella zoster virus.
Neurotic pain is one of the initial symptoms. The red rashes appear on skin, followed by vesicles and pustules.
Herpes zoster should be treated early with antiviral drugs.
Wear soft and comfortable clothes to prevent friction blisters and induced pain.

What is herpes zoster?

Herpes zoster is an infectious disease caused by varicella zoster virus.
After a patient is infected with varicella zoster virus, he or she gets chicken pox. The varicella zoster virus then incubates in the body after the patient recovers from chicken pox.
When the patient's immune system is weakened, the varicella zoster virus gets activated leading to herpes zoster onset in the patient.
Herpes zoster is often accompanied by rashes and stabbing pain which mainly appears on one side of the chest of a patient, followed by the head and neck, waist, and thigh.
The rash appearance on four limbs, hands or feet is less common.

Symptoms of herpes zoster:

Neurotic pain is one of the initial symptoms. The pain may be sharp and involves any part of skin or can spread along nerve innervations.
A cluster of red rashes appears on skin, followed by vesicles and pustules, with band-like spread on one side of body.
Local lymph nodes may be swollen and painful. Fever may also occur.

Treatment of herpes zoster:

Antiviral Therapy: Antiviral drugs are effective if administered for three consecutive days after vesicles eruption, probably followed by inhibition until further eruption.
Pain Reliever: Painkillers can be used to relieve neuropathic pain.
Steroids: If patients with severe inflammation or ocular involvement, steriods can be used combing with antiviral drugs.
Antidepressant: Some types of antidepressants can also be prescribed if there is severe neurotic pain.

Vaccination:

People between the ages of 50 and 79 are suggested to receive a herpes zoster vaccination, which will reduce the probability of experiencing herpes zoster infection and post-herpetic neuralgia.
The vaccine is contraindicated in immunocompromised people. Visit your doctor to further understanding of vaccination.
Herpes zoster vaccine should not be used along with pneumococcal vaccine (Pneumovax 23) as it will reduce its effect.

Self-care for managing herpes zoster:

Do not puncture the blisters to avoid transmission or secondary bacterial infection.
Clean gauze can be used to cover rashes to decrease rubbing. Avoid scratching rashes and wear gloves at night to prevent the rubbing.
Wear soft and loose clothes to avoid the skin from being rubbed.
Apply a thin layer of the ointment prescribed by your doctor on the rashes. Rashes should be clean by normal saline water before the ointment is applied.
If rashes appear on your head, you can raise the head of bed when you sleep; if rashes appear on your four limbs, you can put pillows under your limbs to relieve the discomfort.
Keep a regular and healthy lifestyle in order to distract yourself from the discomfort.
Avoid drinking alcohol and spicy food.

Reference

Brogie, J. D., Rumph, J.H., Chaplin, M.D., Drake, N., Hodge, B. K., & Owens, R. E. (2019). Practical points for applying herpes zoster vaccine recommendations. The Nurse Practitioner, 44(9), 43-47.
Carter, T. M. (2020). Shingles: Not Just a Rash. The Journal for Nurse Practitioners, 16(2), 111-115.
Luo, Y., Chen, Y. U. (2017). Varicella-Herpes Zoster Treatment of Chinese and Western Medicine. Northern Taiwanese Journal of Traditional Chinese Medicine, 9(1), 35-45.

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