Sunday, January 15, 2006

herpes zoster (shingles)

Herpes zoster, or shingles, is a viral infection of the peripheral nerves. It occurs as a result of reactivation of latent varicella virus (the virus that causes chicken pox) from sensory ganglia. It is seen frequently in the elderly; in illnesses that alter cell-mediated immunity such as Hodgkin's disease; in other lymphomas; in corticosteroid therapy; and in immunosuppression and radiation therapy. Incidence of herpes zoster in the elderly is 6.5 per 1,000 in persons 60 to 79 years of age and 10 per 1,000 in persons over age 80. The patient usually develops a rash characterized by clusters of vesicles on an erythematous base in a dermatomal distribution. The rash usually lasts one to two weeks with varying degrees of pain. Postherpetic neuralgia (pain along nerve pathway) may occur in 30 percent to 40 percent of the elderly and occurs more frequently after involvement of the trigeminal nerve.
Treatment consists of the administration of prednisone in rapidly tapering dosages over one to two weeks. Topical analgesia with lotions containing benzocaine is frequently effective. Other drugs used in treating postherpetic neuralgia are phenytoin, the combination of amitriptyline and prolixin, or chlorprothixene. Because herpes zoster is frequently a recurrent problem, some people take lysine (dietary supplement-amino acid) on a regular basis as a preventive measure.
Covington, T., and Walker, J. Current Geriatric Therapy. Philadelphia: W. B. Saunders, 1984.


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