HERPES ZOSTER (SHINGLES)

• Shingles refers to the segmental arrangement of the eruption. Shingles (herpes zoster) is a dermatomal rash with painful blistering that is caused by the reactivation of the varicella-zoster virus
• The initial infection usually occurs early in life, presenting as chickenpox (varicella), after which the virus remains dormant in the dorsal root ganglia. It gets reactivated after many years and the virus replicates in the dorsal root ganglia and travels through peripheral sensory nerves to the skin and causes shingles

• Causative pathogen: Varicella-zoster virus. Transmission occurs via respiratory droplets and direct contact with infected vesicular fluid, causing chickenpox in those infected

Risk factors

• Reactivation typically occurs in immunocompromised individuals
• Decline in immune function with advancing age
• Malignancy
• HIV infection
• Immunosuppressive therapy

• The first symptoms are usually pain and paraesthesia in the involved dermatome. This often precedes the eruption by several days and varies from superficial itching, tingling, burning or lancinating pain. The rash is nearly always unilateral
• It begins as closely grouped maculopapules, which rapidly become vesicular in 12- 24 hours and then pustular in 2-3 days. The lymph node draining that area becomes enlarged and tender. The lesions dry up and crust in 7 to 10 days.
• Typically affecting 1–3 dermatomes on one side of the body (most commonly affects the cervical, trigeminal, thoracic, and lumbar dermatomes) 
• Pain is the most frequent symptom and may precede the rash, usually described as burning, throbbing, or stabbing. Allodynia may occur
• Additional symptoms include Fever, headache, fatigue, Paresthesia, Itching and Motor deficits (rare) 

Disseminated herpes zoster: Herpes zoster characterized by> 20 extra dermatomal lesions, involvement of ≥ 3 dermatomes, and/or visceral organ involvement

Herpes zoster ophthalmicus: Reactivation of Varicella zoster virus in the ophthalmic division of the trigeminal nerve. Involvement of the ophthalmic nerve produce reduced corneal sensitivity with severe pain in the innervated regions (forehead, bridge and tip of the nose). Involvement of the nasociliary nerve produce possible severe intraocular infection (uveitis, iritis, conjunctivitis, keratitis, and optic neuritis) and Positive Hutchinson sign of the nose (vesicles on the side or on the tip of nose)

Herpes zoster oticus: Reactivation of varicella virus in the geniculate ganglion, affecting the facial and vestibulocochlear cranial nerves (also known as Ramsay Hunt syndrome). Vertigo and sensory neural hearing loss, facial paralysis may be seen

Complications

• Postherpetic neuralgia: chronic neuropathic pain persisting for at least three months in the area previously affected by the rash. Pain (including allodynia, paresthesias, dysesthesias) in the same dermatome as the rash is seen
• Herpes zoster encephalitis: Usually manifests as acute or sub acute delirium within days of vesicular eruption and focal neurologic deficits

• Clinical presentation is usually sufficient for a diagnosis.
• PCR of varicella zoster virus
• Serologic assay (IgM and IgG) can be used to identify active or passive immunity and diagnose primary infection 

Internal Medicines

• Patola katurohinyadi kashaya
• Amrutarishta +Punarnavasava
• Gorochanadi gutika
• Gopeechandanadi gutika
• Sudarshana gutika – reduce pain ,fever
• Lodrasevyadi kashaya
• Jeevanthyadi kashaya – in neuralgia
• Guduchi stawa- in burning sensation

Procedure

• Neelidaladi taila – ext application in pain
• Ksheera bala ext application - in pain
• Dashamoola kashaya dhara
• Shatadhouta ghrita ext application