Anticonvulsants such as gabapentin (neurontin) and pregabalin (lyrica).Tricyclic antidepressants such as amitriptyline and nortriptyline.Topical anaesthetic agents such as topical lidocaine gel (5 %).The aim is to shorten the clinical course of the acute infection and post herpetic neuralgia. Antiviral agents such as acyclovir, valaciclovir and famciclovir.Analgesics such as topical capsaicin cream (zostrix cream) The following treatments are available.There may be a role in Ramsay Hunt syndrome. Oral steroids are not recommended as treatment for the common form of shingles.Bed rest, analgesia, antibiotics for secondary infection and moisturising ointment for the rash and subsequent crusting.Treatment of herpes ophthalmicus and Ramsay Hunt syndrome is usually referred to the relevant specialists for treatment.Alternative medications include valaciclovir and famciclovir. The dose may be modified depending on weight, age, renal function and immune competence. For the acute phase, the usual treatment in an otherwise well adult is 800mg acyclovir five times a day for 7 to 10 days, as soon as the diagnosis is made or within 1 to 3 days if possible.The interpretation of the results can be a problem at times. Blood test for the herpes zoster IgM and IgG antibodies.This test separates herpes zoster from herpes simplex. This test amplifies the viral DNA and can be detected by a specific probe. Viral skin swab to test for polymerase chain reaction.This may be a problem if there is no rash, the so-called “zoster sine herpete” or if there is an extensive rash as in immunocompromised patients. You should seek prompt medical attention if shingles occurs in pregnancy. Shingles in early pregnancy is unlikely to affect the foetus because of immunity in the past from varicella (chicken pox). involvement of other organs of the body such as lungs, liver, brain and spinal cord.post inflammatory hypopigmentation ( loss of pigmentation).Facial nerve involvement causing facial paralysis.This is condition is called Ramsay Hunt syndrome and results in earache, hearing loss, dizziness, tinnitus and rash around the ear. Hearing loss from the involvement of the nerve innervation to the ear and ear canal.This can cause scarring and ulceration of the cornea, impairment of visual acuity and secondary glaucoma. Vision impairment from painful eye infections involving the ophthalmic nerve.The pain described can be a continuous or intermittent burning sensation and there may be a change in touch sensation, ie numbness or increased sensitivity. This can persist for months or years and can be debilitating. Post herpetic neuralgia is persisting pain in the area affected by the shingles that occurs after the acute rash has healed.The oral cavity and ear canal can be affected in some cases. Then it is followed by crusting and healing, and sometimes scarring. The acute phase settles over a 3-week period. It commonly stops at the midline but can occasionally involve multiple dermatomes or become bilateral. The rash is a unilateral band-like eruption involving dermatomes (one-sided sections of skin related to the nerve supply to that area) of the chest, neck abdomen or face. These symptoms may precede the appearance of the rash which consists of redness of the skin followed by blisters. The person may have a fever and feel unwell. The virus can lie dormant in nerve cells once a person has contracted chicken pox and may be reactivated by stress, illness, immunosuppression, older age, trauma, radiotherapy and contact with another person with varicella or herpes zoster.Ī person suffering from shingles may experience burning pain, stinging, itching or a change in sensation in affected skin. Shingles is caused by the reactivation of the varicella virus, the same virus responsible for chicken pox. It can involve the chest, neck, abdomen, face or ear canal and central nervous system. Shingles is a localised, blistering, red and painful rash. Also known as herpes zoster, varicella zoster
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