Herpes zoster

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Herpes zoster

Herpes zoster is infection that results when varicella-zoster virus reactivates from its latent state in a posterior dorsal root ganglion. Symptoms usually begin with pain along the affected dermatome, followed in 2 to 3 days by a vesicular eruption that is usually diagnostic. Treatment is antiviral drugs given within 72 h after skin lesions appear.

Chickenpox and herpes zoster are caused by the varicella-zoster virus (human herpesvirus type 3); chickenpox is the acute invasive phase of the virus, and herpes zoster (shingles) represents reactivation of the latent phase.

Herpes zoster inflames the sensory root ganglia, the skin of the associated dermatome, and sometimes the posterior and anterior horns of the gray matter, meninges, and dorsal and ventral roots. Herpes zoster frequently occurs in elderly and HIV-infected patients and is more severe in immunocompromised patients because cell-mediated immunity in these patients is decreased. There are no clear-cut precipitants.

Symptoms and Signs

Lancinating, dysesthetic, or other pain develops in the involved site, followed in 2 to 3 days by a rash, usually crops of vesicles on an erythematous base. The site is usually one or more adjacent dermatomes in the thoracic or lumbar region, although a few satellite lesions may also appear. Lesions are typically unilateral. The site is usually hyperesthetic, and pain may be severe. Lesions usually continue to form for about 3 to 5 days.

Herpes Zoster (Thoracic Dermatome)
Herpes Zoster (Thoracic Dermatome)

© Springer Science+Business Media

Herpes Zoster (Lumbar Dermatome)
Herpes Zoster (Lumbar Dermatome)

© Springer Science+Business Media

Herpes zoster may disseminate to other regions of the skin and to visceral organs, especially in immunocompromised patients.

Geniculate zoster (Ramsay Hunt syndrome, herpes zoster oticus) results from involvement of the geniculate ganglion. Ear pain, facial paralysis, and sometimes vertigo occur. Vesicles erupt in the external auditory canal, and taste may be lost in the anterior two thirds of the tongue.

Ophthalmic herpes zoster results from involvement of the gasserian ganglion, with pain and vesicular eruption around the eye and on the forehead, in the distribution of the ophthalmic division of the 5th cranial nerve. Ocular disease can be severe. Vesicles on the tip of the nose (Hutchinson sign) indicate involvement of the nasociliary branch and a higher risk of severe ocular disease. However, the eye may be involved in the absence of lesions on the tip of the nose.

Intraoral zoster is uncommon but may produce a sharp unilateral distribution of lesions. No intraoral prodromal symptoms occur.

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Maksuturva
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