What is herpes zoster?
Herpes zoster is generally characterized as a unilateral, painful, vesicular rash distributed along the dermis, which is also known as the “snake” in local vernacular, is an infectious disease caused by varicella zoster virus, one of the filterable viruses. 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 has low immunity, the varicella zoster virus gets activated leading to herpes zoster 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. The elderly or immunocompromised people are more susceptible to suffer from herpes zoster infection. Acute symptoms include rashes and pain on the skin, general discomfort and flu-like symptoms. Natural course of the disease takes around three to four weeks.
 
Symptoms of herpes zoster:
  1. Neurotic pain is one of the initial symptoms such as burning pain, tingling and itching. This pain may be localized sharp pain or along the direction of a sensory nerve.
  2. A cluster of red rashes appears on skin, followed by vesicles and pustules, with band-like spread on one side of body. 
  3. Local lymph nodes may be swollen and painful. Fever may also occur.
People with the above symptoms should not be as herpes zoster only. Thus, if you have the above mentioned symptoms, please visit a dermatologist as soon as possible.
 
Treatment of herpes zoster:
  1. Antiviral drugs are very effective if administered earlier, it is better given in the first three consecutive days after vesicles eruption. 
  2. Pain killers can be used to relive the neurotic pain.
  3. Corticosteroid therapy combined with antiviral agents can be used on the patients who have acute inflammation or herpes zoster in the eyes. 
  4. In addition to regular pain killers, oral antidepressants may be also prescribed at night to relive severe neurotic pain.
 
Self-care for herpes zoster:
  1. Don’t apply over-the-counter ointments on rashes or puncture vesicles by yourself in order to avoid transmission or secondary bacterial infection. Cover clean gauze on the rashes to avoid rubbing.
  2. Apply a thin layer of the ointment prescribed by your doctor on the rashes. Clean off the old ointment before applying new ointment. 
  3. If rashes appear on your head, you can raise the head of your bed when you sleep; if rashes appear on your four limbs, you can put pillows under your limbs in order to relieve the discomfort. 
  4. Wear gloves at night to protect your skin from scratching. 
  5. Wear soft and loose clothes to avoid friction blisters and induced pain. 
  6. Return to the original regular life as soon as possible in order to distract yourself from the discomfort.
  7. No food should be limited, but only avoid drinking alcohol and eating spicy food.
 
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. However, the vaccine is contraindicated in immunocompromised people. Visit your doctor to further understand the importance of the vaccine. Herpes zoster vaccine should not be used along with pneumococcal vaccine (Pneumovax 23) as it will reduce its effect.
 
Reference
  1. 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.
  2. Carter, T. M. (2020). Shingles: Not Just a Rash. The Journal for Nurse Practitioners, 16(2), 111-115.
  3. 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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