Herpes zoster

Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. Caused by varicella zoster virus.

Once an individual got this herps attack,  the varicella zoster virus remains latent in the nerve cell bodies and, less frequently, the non-neuronal satellite cells of the dorsal root, cranial nerve or autonomic ganglia, without causing any symptoms.

Years or decades after the initial infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve (as shown in the below figure). The virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash.

Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia. which is often difficult to manage.




Progression of herpes zoster.
1). A cluster of small bumps. 2.) turns into blisters 3). The blisters fill with lymph, break open 4), crust over  5), and finally disappear. Postherpetic neuralgia can sometimes occur due to nerve damage


HERPS ZOOSTER AND THE NERVE DAMAGE:

Herpes zoster may have additional symptoms, depending on the dermatome involved. Herpes zoster ophthalmicus involves the orbit of the eye and occurs in approximately 10% to 25% of cases. It is caused by the virus reactivating in the ophthalmic division of the trigeminal nerve.

In a few patients, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain. Herpes zoster oticus, also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness)

 
In some patients, herpes zoster can reactivate presenting as zoster sine herpete: pain radiating along the path of a single spinal nerve (a dermatomal distribution), but without an accompanying rash. This condition may involve complications that affect several levels of the nervous system and cause many cranial neuropathies, polyneuritis, myelitis, or aseptic meningitis. Other serious effects that may occur in some cases include partial facial paralysis (usually temporary), ear damage, or encephalitis.

Although herpes zoster typically resolves within 3–5 weeks, certain complications may arise:

  • Secondary bacterial or fungal  infection may cause serious skin disease.

Signs and symptoms

The earliest symptoms of herpes zoster, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis.

These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia ("pins and needles": tingling, pricking, or numbness on the skin surface)
The pain may be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.
Herpes zoster in children is often painless, but older people are more likely to get zoster as they age, and the disease tends to be more severe.

The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. At first the rash appears similar to the first appearance of hives; however, unlike hives, herpes zoster causes skin changes limited to a dermatome, normally resulting in a stripe or belt-like pattern that is limited to one side of the body and does not cross the midline. Zoster sine herpete ("zoster without herpes") describes a patient who has all of the symptoms of herpes zoster except this characteristic rash.

Later the rash becomes vesicular, forming small blisters filled with a serous exudate, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, and crust over within seven to ten days; usually the crusts fall off and the skin heals, but sometimes, after severe blistering, scarring and discolored skin remain.


Prevention

  • Avoid contact with the infected persons till gets cure, ( includes swimming in a common pool, bathing together, sexual contact with high sweating)
  • avoid contact of sweat , sweated clothing’s of infected person,
  • Avoid use of  used clothing’s, towel, kerchief of used persons,
  • Avoid strong direct hot sun, Take bath with good toilet soap immediately after ever long outing and don’t go to bed before bathing,
  • Wash face and hands regularly at least 3 times a day and take bath two times a day.

Treatment

Herbal treatments involves application of herbal infused oils, herbal medicines to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications.

Symptomatic treatment is often needed for the complication of postherpetic neuralgia. (nerve pain) for which herbal pain reliever medicine and body cooling herbs are very useful